Healthcare Provider Details

I. General information

NPI: 1487819942
Provider Name (Legal Business Name): PRIMARY CARE ASSOCIATES OF SOUTH BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FLORIDA AVE SUITE 10
MIAMI FL
33133-1905
US

IV. Provider business mailing address

1450 MERIDIAN AVE SUITE 10
MIAMI BEACH FL
33139-8059
US

V. Phone/Fax

Practice location:
  • Phone: 305-534-8300
  • Fax: 305-534-6445
Mailing address:
  • Phone: 305-534-8300
  • Fax: 305-534-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2987482
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2987482
License Number StateFL

VIII. Authorized Official

Name: DR. EDWARD MICHAEL FREEMAN
Title or Position: PRESIDENT
Credential: PHD, ARNP, BC
Phone: 305-534-8300