NPIMap

Organization Active NPI

Primary Care Center of Port Orange

  • Family Medicine Physician
  • Port Orange, FL
National Provider Identifier
1295910834
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0028054 Issued in FL
Legal business name
PRIMARY CARE CENTER OF PORT ORANGE
Practice address
4770 S Ridgewood Ave
Suite 1
Port Orange, FL 32127-4544
Phone
(386) 761-0050
Fax
(386) 761-1167
NPI assigned
Jan 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Michelle L Jackson
Title
Office Manager
Phone
(386) 761-0050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME0028054 FL Primary

Addresses

Primary practice location

4770 S Ridgewood Ave
Suite 1
Port Orange, FL 32127-4544

Mailing address

4770 S Ridgewood Ave
Suite 1
Port Orange, FL 32127-4544
Phone (386) 761-0050

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1295910834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "386-761-0050",
            "fax_number": "386-761-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "386-761-0050",
            "fax_number": "386-761-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE CENTER OF PORT ORANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "386-761-0050",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0028054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.