Provider Demographics
NPI:1730117888
Name:PRIMARY CARE OF VENICE INC
Entity Type:Organization
Organization Name:PRIMARY CARE OF VENICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-492-2212
Mailing Address - Street 1:1211 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4520
Mailing Address - Country:US
Mailing Address - Phone:941-492-2212
Mailing Address - Fax:941-496-9307
Practice Address - Street 1:1211 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4520
Practice Address - Country:US
Practice Address - Phone:941-492-2212
Practice Address - Fax:941-496-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028168207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068196200Medicaid
FL45193Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLD86085Medicare UPIN