Provider Demographics
NPI:1093007387
Name:PRIMENET MEDICAL GROUP OF KENDALL
Entity Type:Organization
Organization Name:PRIMENET MEDICAL GROUP OF KENDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-1220
Mailing Address - Street 1:9000 SW 137TH AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1411
Mailing Address - Country:US
Mailing Address - Phone:305-387-1981
Mailing Address - Fax:305-387-1939
Practice Address - Street 1:9000 SW 137TH AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1411
Practice Address - Country:US
Practice Address - Phone:305-387-1981
Practice Address - Fax:305-387-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037965400Medicaid
FL045341200Medicaid
FLD20789Medicare UPIN
FL045341200Medicaid