Provider Demographics
NPI:1366647661
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 1:1800 MERCY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5646
Mailing Address - Country:US
Mailing Address - Phone:407-523-3523
Mailing Address - Fax:
Practice Address - Street 1:1800 MERCY DR
Practice Address - Street 2:STE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5646
Practice Address - Country:US
Practice Address - Phone:407-523-3523
Practice Address - Fax:407-523-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4920Medicare PIN