Healthcare Provider Details

I. General information

NPI: 1841707171
Provider Name (Legal Business Name): PRIMECARE FAMILY MEDICAL CENTERS OSCEOLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E OAK ST
KISSIMMEE FL
34744-4503
US

IV. Provider business mailing address

7765 NW 48TH ST STE 300
DORAL FL
33166-5404
US

V. Phone/Fax

Practice location:
  • Phone: 407-988-1035
  • Fax: 407-988-1034
Mailing address:
  • Phone: 305-442-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME78770
License Number StateFL

VIII. Authorized Official

Name: RENE CASANOVA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 305-442-1740