Provider Demographics
NPI:1750302626
Name:PRIME HEALTH MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PRIME HEALTH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-981-4700
Mailing Address - Street 1:4724 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:305-981-4700
Mailing Address - Fax:305-981-2600
Practice Address - Street 1:18250 NW 2ND AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:786-280-6474
Practice Address - Fax:305-249-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078304207Q00000X
FLME0071876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253658700Medicaid
G61958Medicare UPIN
FL253658700Medicaid
FL44474Medicare ID - Type Unspecified