Provider Demographics
NPI:1720424021
Name:PRIMARY CARE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-604-2888
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 860
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-604-2888
Mailing Address - Fax:305-604-2887
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 860
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-604-2888
Practice Address - Fax:305-604-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9257323363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262609800Medicaid
FL262609800Medicaid