Organization
PRIMECARE PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT C KELSEY MD (PRESIDENT)
(904) 827-0078
Entity
Organization
Contact information
Practice address
2720 US HIGHWAY 1 S # B, ST AUGUSTINE, FL 32086-6301
(904) 827-0078
(904) 827-0140
Mailing address
2720 US HIGHWAY 1 S # B, ST AUGUSTINE, FL 32086-6301
(904) 827-0078
(904) 827-0140
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME58662
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270845101
—
FL
05
—
270845102
—
FL
05
—
270845104
—
FL
05
—
270845105
—
FL
05
—
270845106
—
FL
01
—
97705
BCBS
FL
Enumeration date
12/04/2007
Last updated
11/18/2015
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