Provider Demographics
NPI:1235336132
Name:PRIMARY CARE SERVICES OF POLK COUNTY INC
Entity Type:Organization
Organization Name:PRIMARY CARE SERVICES OF POLK COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CEFERINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-7778
Mailing Address - Street 1:103 ESCAMBIA
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-4119
Mailing Address - Country:US
Mailing Address - Phone:863-421-7778
Mailing Address - Fax:863-421-7795
Practice Address - Street 1:103 ESCAMBIA
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-4119
Practice Address - Country:US
Practice Address - Phone:863-421-7778
Practice Address - Fax:863-421-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ221Medicare PIN