Provider Demographics
NPI:1669909305
Name:ADVANCE PRIMARY CARE LLC
Entity type:Organization
Organization Name:ADVANCE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-286-9255
Mailing Address - Street 1:1133 SE 18TH PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5410
Mailing Address - Country:US
Mailing Address - Phone:352-861-5765
Mailing Address - Fax:352-867-1801
Practice Address - Street 1:1133 SE 18TH PL
Practice Address - Street 2:SUITE 2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-861-5765
Practice Address - Fax:352-867-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN-194208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280272400Medicaid
FLAJ517ZMedicare PIN