Provider Demographics
NPI:1568177632
Name:PRIMARY CARE IN THE HOME, INC
Entity Type:Organization
Organization Name:PRIMARY CARE IN THE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-548-8735
Mailing Address - Street 1:3098 EAGLE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3160
Mailing Address - Country:US
Mailing Address - Phone:407-201-2680
Mailing Address - Fax:407-201-2680
Practice Address - Street 1:3098 EAGLE CROSSING DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3160
Practice Address - Country:US
Practice Address - Phone:407-201-2680
Practice Address - Fax:407-201-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016105300Medicaid