Provider Demographics
NPI:1104311315
Name:SANTOS PRIMARY CARE MEDICAL CLINICS, PLLC
Entity type:Organization
Organization Name:SANTOS PRIMARY CARE MEDICAL CLINICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADAMASTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:352-448-6469
Mailing Address - Street 1:17820 SE 109TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-448-6469
Mailing Address - Fax:352-504-0901
Practice Address - Street 1:17820 SE 109TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-448-6469
Practice Address - Fax:352-504-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty