Provider Demographics
NPI:1487819942
Name:PRIMARY CARE ASSOCIATES OF SOUTH BEACH, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF SOUTH BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ARNP, BC
Authorized Official - Phone:305-534-8300
Mailing Address - Street 1:1450 MERIDIAN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-8059
Mailing Address - Country:US
Mailing Address - Phone:305-534-8300
Mailing Address - Fax:305-534-6445
Practice Address - Street 1:2801 FLORIDA AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-1905
Practice Address - Country:US
Practice Address - Phone:305-534-8300
Practice Address - Fax:305-534-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2987482363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194919050OtherNPI