Provider Demographics
NPI:1891333472
Name:PRIMARY CARE MEDICAL CENTERS OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:PRIMARY CARE MEDICAL CENTERS OF SOUTH FLORIDA LLC
Other - Org Name:PRIMARY CARE MEDICAL CENTERS OF SOUTH FLORIDA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-375-0036
Mailing Address - Street 1:1840 W 49TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2978
Mailing Address - Country:US
Mailing Address - Phone:786-375-0036
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 420
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2978
Practice Address - Country:US
Practice Address - Phone:786-703-3085
Practice Address - Fax:786-703-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-14
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care