Provider Demographics
NPI:1124002613
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 1:11140 W COLONIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3300
Mailing Address - Country:US
Mailing Address - Phone:407-877-2111
Mailing Address - Fax:407-877-7571
Practice Address - Street 1:11140 W COLONIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3300
Practice Address - Country:US
Practice Address - Phone:407-877-2111
Practice Address - Fax:407-877-7571
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
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24506FOtherBCBS GROUP
FLK4920DMedicare PIN