Provider Demographics
NPI:1992457444
Name:MEDICS PRIMARY CARE
Entity type:Organization
Organization Name:MEDICS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:JULISSA
Authorized Official - Last Name:GANDIA-MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-406-2577
Mailing Address - Street 1:484 SW COMMERCE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1508
Mailing Address - Country:US
Mailing Address - Phone:386-406-2577
Mailing Address - Fax:
Practice Address - Street 1:484 SW COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1508
Practice Address - Country:US
Practice Address - Phone:386-406-2577
Practice Address - Fax:855-618-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care