Healthcare Provider Details

I. General information

NPI: 1760769681
Provider Name (Legal Business Name): PRIMARY MEDICAL CARE CENTER AND URGENT CARE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2011
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 NW 7TH AVE
MIAMI FL
33168
US

IV. Provider business mailing address

11500 NW 7TH AVE
MIAMI FL
33168-2506
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-1500
  • Fax: 305-751-1507
Mailing address:
  • Phone: 305-751-1500
  • Fax: 305-751-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: PRINSTON JEAN-GLAUDE
Title or Position: CFO
Credential:
Phone: 305-751-1500