Provider Demographics
NPI:1659817807
Name:PRIMARY CARE SERVICES OF JUPITER MEDICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SERVICES OF JUPITER MEDICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-838-2371
Mailing Address - Street 1:PO BOX 744078
Mailing Address - Street 2:DEPT 70003
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1004 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7200
Practice Address - Country:US
Practice Address - Phone:561-972-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty