Provider Demographics
NPI:1487849824
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 1:60 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1141
Mailing Address - Country:US
Mailing Address - Phone:407-650-1300
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1141
Practice Address - Country:US
Practice Address - Phone:407-650-1300
Practice Address - Fax:407-650-1307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4920GMedicare PIN