Healthcare Provider Details

I. General information

NPI: 1801426606
Provider Name (Legal Business Name): PRIMARY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 CITRUS TOWER BLVD STE A
CLERMONT FL
34711-6853
US

IV. Provider business mailing address

3170 CITRUS TOWER BLVD STE A
CLERMONT FL
34711-6853
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-5219
  • Fax:
Mailing address:
  • Phone: 352-394-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ALLIE TORRES
Title or Position: CFO, COO
Credential:
Phone: 352-394-5219