Provider Demographics
NPI:1912980632
Name:PRIMARY CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-275-9014
Mailing Address - Street 1:3615 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6216
Mailing Address - Country:US
Mailing Address - Phone:407-855-2526
Mailing Address - Fax:407-855-1503
Practice Address - Street 1:3615 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6216
Practice Address - Country:US
Practice Address - Phone:407-855-2526
Practice Address - Fax:407-855-1503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-28
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC3239OtherRAIL ROAD MEDICARE
FLK4920EMedicare PIN