MEDICARE: PRIMENET MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104251081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMENET MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1100 S STATE ROAD 7
Second Line	:	SUITE 104
City	:	MARGATE
State	:	FL
Zip	:	33068-4033
Country	:	US
Telephone Number	:	954-984-8000
Fax Number	:	954-984-8811

Provider Business Practice Location Address
First Line	:	1100 S STATE ROAD 7
Second Line	:	SUITE 104
City	:	MARGATE
State	:	FL
Zip	:	33068-4033
Country	:	US
Telephone Number	:	954-984-8000
Fax Number	:	954-984-8811

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MAGGIE TORRES
Credential	:
Telephone Number	:	954-983-1220

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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Directions to “PRIMENET MEDICAL GROUP, INC. ” Practice Location

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