Provider Demographics
NPI:1568573624
Name:PRIMECARE, LLC
Entity Type:Organization
Organization Name:PRIMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:REVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-514-6750
Mailing Address - Street 1:1753 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-1820
Mailing Address - Country:US
Mailing Address - Phone:813-514-6750
Mailing Address - Fax:813-514-6751
Practice Address - Street 1:1753 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-1820
Practice Address - Country:US
Practice Address - Phone:813-514-6750
Practice Address - Fax:813-514-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty