Provider Demographics
NPI:1922544741
Name:RIVERVIEW PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:RIVERVIEW PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PULCINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-269-6426
Mailing Address - Street 1:12967 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7647
Mailing Address - Country:US
Mailing Address - Phone:813-443-6369
Mailing Address - Fax:813-280-2584
Practice Address - Street 1:12967 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7647
Practice Address - Country:US
Practice Address - Phone:813-443-6369
Practice Address - Fax:813-280-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG20297Medicare UPIN