Provider Demographics
NPI:1265614754
Name:PRIMARY CARE SPECIALISTS OF THE PALM BEACHES LLC
Entity type:Organization
Organization Name:PRIMARY CARE SPECIALISTS OF THE PALM BEACHES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2000
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:6101 BLUE LAGOON DR STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2051
Practice Address - Country:US
Practice Address - Phone:305-662-5200
Practice Address - Fax:305-284-7948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE SPECIALISTS OF THE PALM BEACHES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012616300Medicaid
FL012616302Medicaid
FL012616303Medicaid
FL012616301Medicaid
FL012616303Medicaid