Organization
PRIMECARE AT TWIN LAKES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DUVA M.D. (PRESIDENT)
(386) 274-7800
Entity
Organization
Contact information
Practice address
1890 LPGA BLVD, STE 130, DAYTONA BEACH, FL 32117-7130
(386) 274-2212
(386) 274-1508
Mailing address
1890 LPGA BLVD, SUITE 130, DAYTONA BEACH, FL 32117-7130
(386) 274-2212
(386) 274-1508
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
ME47294
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77984
BC/BS OF FL PA GROUP
FL
01
—
B90F7
FLORIDA BLUE
FL
01
—
DC0901
RAILROAD MEDICARE GROUP
FL
Enumeration date
05/23/2005
Last updated
03/21/2022
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