Provider Demographics
NPI:1427014158
Name:PRIMENET MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PRIMENET MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-1220
Mailing Address - Street 1:7189 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023
Mailing Address - Country:US
Mailing Address - Phone:954-983-1220
Mailing Address - Fax:954-983-0687
Practice Address - Street 1:7189 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33023
Practice Address - Country:US
Practice Address - Phone:954-983-1220
Practice Address - Fax:954-983-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003094200Medicaid
FL370428900Medicaid
FL045341200Medicaid
FL254724400Medicaid
FL277531000Medicaid
FL259691100Medicaid
FL370428901Medicaid
FL370428902Medicaid
FL037965400Medicaid
E34018Medicare UPIN
FLH31988Medicare UPIN
FL254724400Medicaid
FLCN141ZMedicare UPIN
FL370428900Medicaid
FL003094200Medicaid
FL037965400Medicaid
FL00237Medicare PIN