Provider Demographics
NPI:1396713558
Name:PRIMARY CARE ASSOCIATES OF PUTNAM COUNTY, PA
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF PUTNAM COUNTY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-325-9008
Mailing Address - Street 1:108 N. PALM AVE.
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2626
Mailing Address - Country:US
Mailing Address - Phone:386-325-9008
Mailing Address - Fax:386-325-7098
Practice Address - Street 1:108 N PALM AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2626
Practice Address - Country:US
Practice Address - Phone:386-325-9008
Practice Address - Fax:386-325-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38530Medicare ID - Type Unspecified