MEDICARE: FIRST PRIME MEDICAL CENTER INC

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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336H0001X	Home Infusion Therapy Pharmacy	PH23631	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1042148	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508854621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST PRIME MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	6405 NW 36TH ST STE 113
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 NW 36TH ST STE 113
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6977
Country	:	US
Telephone Number	:	305-870-9393
Fax Number	:	305-870-9373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MADELYN RODRIGUEZ
Credential	:
Telephone Number	:	305-870-9393

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/11/2009

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Directions to “FIRST PRIME MEDICAL CENTER INC ” Practice Location

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