Basic Information
| Provider Information | |||||||||
| NPI: | 1558726802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMECARE DOCTORS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 MARINER BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346095657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527969994 | ||||||||
| FaxNumber: | 3527969934 | ||||||||
| Practice Location | |||||||||
| Address1: | 9030 W FORT ISLAND TRL | ||||||||
| Address2: | STE 1 | ||||||||
| City: | CRYSTAL RIVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344292412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522288906 | ||||||||
| FaxNumber: | 3522288905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | PARIKSITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3527969994 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME71088 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 016510400 | 05 | FL | MEDICAID | 016510401 | 05 | FL | MEDICAID | 7Z3JB | 01 | FL | FLORIDA BCBS | OTHER |