Provider Demographics
NPI:1114901691
Name:PRIMARY CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-281-7728
Mailing Address - Street 1:5540 E GRANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1668
Mailing Address - Country:US
Mailing Address - Phone:407-281-7728
Mailing Address - Fax:407-658-1920
Practice Address - Street 1:5540 E GRANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1668
Practice Address - Country:US
Practice Address - Phone:407-281-7728
Practice Address - Fax:407-658-1920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-30
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4920FMedicare PIN