Provider Demographics
NPI:1417537200
Name:RPS PRIMARY MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:RPS PRIMARY MEDICAL CENTER PLLC
Other - Org Name:RPS PRIMARY MEDICAL CENTER PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:689-221-0039
Mailing Address - Street 1:2900 LOOPDALE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7658
Mailing Address - Country:US
Mailing Address - Phone:689-221-0039
Mailing Address - Fax:
Practice Address - Street 1:2900 LOOPDALE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7658
Practice Address - Country:US
Practice Address - Phone:689-221-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty