Organization
PRIMARY CARE OF THE TREASURE COAST, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK MICHAEL LUTON (CEO)
(772) 567-6340
Entity
Organization
Contact information
Practice address
1265 36TH ST, VERO BEACH, FL 32960-6574
(772) 567-6340
(772) 567-6788
Mailing address
PO BOX 1209, VERO BEACH, FL 32961-1209
(772) 567-6340
(772) 567-6788
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800006678
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375002700
—
FL
Enumeration date
05/11/2007
Last updated
03/01/2010
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