Primecare Acquisition Inc

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

ME67318 Issued in FL

Legal business name

PRIMECARE ACQUISITION INC

Doing business as

PrimeCare Urgent Care Centers Twin Lakes

Practice address

1890 Lpga Blvd
Suite 130
Daytona Beach, FL 32117-7130

Phone

(386) 274-2212

NPI assigned

Dec 4, 2013

Organization subpart

Yes

Parent organization

MEDVANTX, INC,As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• PrimeCare Urgent Care Centers Twin Lakes Doing business as

Tax ID family

Primecare Acquisition Inc2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Primecare Acquisition Inc

  dba PrimeCare Urgent Care Centers Port Orange

  • Non-Pharmacy Dispensing Site
  • Port Orange, FL
  • NPI 1780013821
  NPD tax ID

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

{
    "created_epoch": "1386115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1649601485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "SUITE 130",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE ACQUISITION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC,",
        "enumeration_date": "2013-12-04",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME67318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimeCare Urgent Care Centers Twin Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edwin Prevatte, MD
• Sarah-Elisabeth Priest
• Primary Healthcare Alliance Foundation Inc
• Prime Health of Central Florida (Advanced Pediatric Gastroenterology Specialists)
• Primecare Acquisition Family Practice Inc
• Primecare at Twin Lakes LLC
• Primecare at Twin Lakes LLC
• Primecare Family Medicine LLC
• Fay L Prince, RN
• Leeanne Pringle, MS, CCC-SLP

• Non-Pharmacy Dispensing Site in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Non-Pharmacy Dispensing Site in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; 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.