Provider Demographics
NPI:1760613392
Name:PRIMENET MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:PRIMENET MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-1220
Mailing Address - Street 1:13760 SW 56TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6034
Mailing Address - Country:US
Mailing Address - Phone:305-387-1981
Mailing Address - Fax:305-387-1939
Practice Address - Street 1:13760 SW 56TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6034
Practice Address - Country:US
Practice Address - Phone:305-387-1981
Practice Address - Fax:305-387-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037965400Medicaid
FL370428900Medicaid
FL254724400Medicaid
FL259691100Medicaid
FL370428902Medicaid
FL277531000Medicaid
FL370428901Medicaid
FL370428902Medicaid
FLF72513Medicare UPIN
FLOF34995Medicare UPIN
FL277531000Medicaid
FL07824WMedicare UPIN
FL370428900Medicaid