Organization
PRICARE HEALTH LLC
Active
Parent organization
MAIN STREET MEDICAL LLC
Other names
MAIN STREET MEDICAL CENTERS
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAIN STREET MEDICAL LLC
Authorized official
STEPHEN O BANJOKO (CFO)
(212) 257-0225
Entity
Organization
Contact information
Practice address
6506 EMBASSY BLVD, PORT RICHEY, FL 34668-4734
(727) 378-2987
Mailing address
PO BOX 17175, TAMPA, FL 33682-7175
(813) 220-1400
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
10/08/2018
Last updated
08/09/2024
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