Provider Demographics
NPI:1114010824
Name:PRIMARY CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-275-9014
Mailing Address - Street 1:2572 WEST ST RD 426 SUITE 1040
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-366-9800
Mailing Address - Fax:407-366-9283
Practice Address - Street 1:2572 W STATE ROAD 426
Practice Address - Street 2:SUITE 1040
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-366-9800
Practice Address - Fax:407-366-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24506OtherBCBS
FL207Q00000XOtherFAMILY PRACTICE
FL363L00000XOtherNURSE PRACTITIONER
FL24506OtherBCBS