Provider Demographics
NPI:1578123675
Name:PRIMARY CARE SOLUTIONS MEDICAL CENTERS LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SOLUTIONS MEDICAL CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-364-0404
Mailing Address - Street 1:625 SE 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5065
Mailing Address - Country:US
Mailing Address - Phone:561-364-0404
Mailing Address - Fax:561-364-7787
Practice Address - Street 1:625 SE 2ND AVE STE C
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5065
Practice Address - Country:US
Practice Address - Phone:561-364-0404
Practice Address - Fax:561-364-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371924300Medicaid