Provider Demographics
NPI:1548871866
Name:1ST CALL PRIMARY CARE, LLC
Entity type:Organization
Organization Name:1ST CALL PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-820-1099
Mailing Address - Street 1:955 S WOODLAND BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7321
Mailing Address - Country:US
Mailing Address - Phone:662-820-1099
Mailing Address - Fax:
Practice Address - Street 1:955 S WOODLAND BLVD STE A1
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7321
Practice Address - Country:US
Practice Address - Phone:662-820-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care