Provider Demographics
NPI:1760769681
Name:PRIMARY MEDICAL CARE CENTER AND URGENT CARE CLINIC, INC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL CARE CENTER AND URGENT CARE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PRINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-GLAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-751-1500
Mailing Address - Street 1:11500 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2506
Mailing Address - Country:US
Mailing Address - Phone:305-751-1500
Mailing Address - Fax:305-751-1507
Practice Address - Street 1:11500 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:305-751-1500
Practice Address - Fax:305-751-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-05
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X, 261QP2300X, 261QU0200X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ811AMedicare UPIN