Provider Demographics
NPI:1982639100
Name:PRIMARY MEDICAL CARE INC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELLANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-635-1614
Mailing Address - Street 1:3413 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5537
Mailing Address - Country:US
Mailing Address - Phone:305-635-1614
Mailing Address - Fax:305-635-7476
Practice Address - Street 1:3413 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5537
Practice Address - Country:US
Practice Address - Phone:305-635-1614
Practice Address - Fax:305-635-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268338500Medicaid
FLHCC4760OtherAHCA
FL268338500Medicaid