Basic Information
| Provider Information | |||||||||
| NPI: | 1679138689 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUGHES DIRECT PRIMARY CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13731 METROPOLIS AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339127150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Practice Location | |||||||||
| Address1: | 13731 METROPOLIS AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339127150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | TOMLINSON | ||||||||
| AuthorizedOfficialFirstName: | JOY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 2392781155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 1740262542 | 01 | FL | NPI | OTHER | OS9442 | 01 | FL | LICENSE | OTHER |