Provider Demographics
NPI:1679138689
Name:HUGHES DIRECT PRIMARY CARE LLC
Entity type:Organization
Organization Name:HUGHES DIRECT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-1155
Mailing Address - Street 1:9351 CORKSCREW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6801
Mailing Address - Country:US
Mailing Address - Phone:239-278-1155
Mailing Address - Fax:239-278-1159
Practice Address - Street 1:9351 CORKSCREW RD STE 101
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6801
Practice Address - Country:US
Practice Address - Phone:239-278-1155
Practice Address - Fax:239-278-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1740262542OtherNPI
FLOS9442OtherLICENSE