Provider Demographics
NPI:1558726802
Name:PRIMECARE DOCTORS LLC
Entity Type:Organization
Organization Name:PRIMECARE DOCTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARIKSITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-796-9994
Mailing Address - Street 1:1214 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5657
Mailing Address - Country:US
Mailing Address - Phone:352-796-9994
Mailing Address - Fax:352-796-9934
Practice Address - Street 1:9030 W FORT ISLAND TRL
Practice Address - Street 2:STE 1
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2412
Practice Address - Country:US
Practice Address - Phone:352-228-8906
Practice Address - Fax:352-228-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016510400Medicaid
FL016510401Medicaid
FL7Z3JBOtherFLORIDA BCBS
FLIL252AMedicare PIN