MEDICARE: PRIMED PARTNERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1396926697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMED PARTNERS, LLC

Provider Business Mailing Address
First Line	:	5011 N OCEAN BLVD
Second Line	:	SUITE 5
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7355
Country	:	US
Telephone Number	:	877-817-7886
Fax Number	:	877-817-7886

Provider Business Practice Location Address
First Line	:	5011 N OCEAN BLVD
Second Line	:	SUITE 5
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7355
Country	:	US
Telephone Number	:	877-817-7886
Fax Number	:	877-817-7886

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD JOHN LUCIBELLA
Credential	:
Telephone Number	:	877-817-7886

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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