Healthcare Provider Details

I. General information

NPI: 1508854621
Provider Name (Legal Business Name): FIRST PRIME MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 NW 36TH ST STE 113
VIRGINIA GARDENS FL
33166-6977
US

IV. Provider business mailing address

6405 NW 36TH ST STE 113
VIRGINIA GARDENS FL
33166-6977
US

V. Phone/Fax

Practice location:
  • Phone: 305-870-9393
  • Fax: 305-870-9373
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH23631
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MADELYN RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-870-9393