Provider Demographics
NPI:1386419141
Name:ISLAND PRIMARY CARE LLC
Entity type:Organization
Organization Name:ISLAND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:CANADY
Authorized Official - Last Name:BEECH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:228-218-3716
Mailing Address - Street 1:5831 SYLVESTER ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4073
Mailing Address - Country:US
Mailing Address - Phone:228-218-3716
Mailing Address - Fax:
Practice Address - Street 1:5831 SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4073
Practice Address - Country:US
Practice Address - Phone:228-218-3716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center