Organization
ISLAND DIRECT PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WESLEY ROTHWELL III DNP (PRESIDENT)
(321) 506-2540
Entity
Organization
Contact information
Practice address
390 N COURTENAY PKWY, MERRITT ISLAND, FL 32953-3456
(321) 506-2540
Mailing address
210 HICKORY AVE, MERRITT ISLAND, FL 32953-4368
(321) 506-2540
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679943740
—
FL
Enumeration date
10/16/2018
Last updated
03/27/2022
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