NPIMap

Organization Active NPI

Lifetime Medical Care PA

  • Primary Care Clinic/Center
  • Orange Park, FL
National Provider Identifier
1790793016
Registry record updated Nov 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ME81222 Issued in FL
Legal business name
LIFETIME MEDICAL CARE PA
Practice address
2300 Park Ave
Suite 203
Orange Park, FL 32073-5571
Phone
(904) 278-0016
Fax
(904) 278-4217
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2008

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

Authorized official

Name
Nidal El Rimawi, M.D.NPI 1104804525
Title
President
Phone
(904) 278-0016

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X ME81222 FL Primary

Addresses

Primary practice location

2300 Park Ave
Suite 203
Orange Park, FL 32073-5571

Mailing address

5000 US Highway 17
Suite 18-302
Orange Park, FL 32003-8231
Phone (904) 278-0016

Other identifiers 3

IdentifierTypeStateIssuer
7388361OtherFLAETNA
01528OtherFLBLUE CROSS BLUE SHIELD
6965204OtherFLCIGNA

National Provider Directory

National Provider Directory

Locations

5000 US Highway 17
Ste 18302
Orange Park, FL 32003

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225929600000",
    "number": "1790793016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 US HIGHWAY 17",
            "address_2": "SUITE 18-302",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320038231",
            "telephone_number": "904-278-0016",
            "fax_number": "904-278-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PARK AVE",
            "address_2": "SUITE 203",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735571",
            "telephone_number": "904-278-0016",
            "fax_number": "904-278-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME MEDICAL CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-11-06",
        "status": "A",
        "authorized_official_last_name": "EL RIMAWI",
        "authorized_official_first_name": "NIDAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-278-0016",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME81222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7388361",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01528",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6965204",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; 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.