Provider Demographics
NPI:1871394155
Name:PRIMECARE HEALTH GROUP LLC
Entity type:Organization
Organization Name:PRIMECARE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMCEAU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-537-1260
Mailing Address - Street 1:15050 ELDERBERRY LN STE 6-10
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8504
Mailing Address - Country:US
Mailing Address - Phone:239-537-1260
Mailing Address - Fax:239-790-5073
Practice Address - Street 1:15050 ELDERBERRY LN STE 6-10
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8504
Practice Address - Country:US
Practice Address - Phone:239-537-1260
Practice Address - Fax:239-790-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty