DYNAMIC PRIMARY HEALTHCARE CLINIC NPI 1710633144

NPI Information

  • NPI: 1710633144
  • Provider Name: DYNAMIC PRIMARY HEALTHCARE CLINIC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 10D2260456
  • Address: 163 SW STONEGATE TER STE 109
    LAKE CITY, FL
    ZIP 32024
  • Phone: (330) 323-8976

Map and Directions

Get Directions

NPI Details

DYNAMIC PRIMARY HEALTHCARE CLINIC is a family medicine in Lake City, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DYNAMIC PRIMARY HEALTHCARE CLINIC NPI is 1710633144. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

163 SW STONEGATE TER STE 109
LAKE CITY, FL
ZIP 32024-459
Phone: (330) 323-8976

The provider's authorized official is John Distefano .
The authorized official title is Business Manager and has the following contact phone number (352) 317-3214.

The CLIA number assigned to this NPI record is 10D2260456 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/24/2022 and was last updated on 3/18/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI