MEDICARE: PRIMARY CARE SPECIALISTS LLC

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

General Provider Information

NPI Number	:	1215910864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3100 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7331
Country	:	US
Telephone Number	:	407-380-2216
Fax Number	:	407-380-2710

Provider Business Practice Location Address
First Line	:	3100 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7331
Country	:	US
Telephone Number	:	407-380-2216
Fax Number	:	407-380-2710

Authorized Official
Title or Position	:	PARTNER
Name	:	GERALD J KIVETT
Credential	:	MD
Telephone Number	:	407-275-9014

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	11/18/2011

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