MEDICARE: PRIMARY CARE MEDICAL SERVICES

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	208000000X	Pediatrics Physician	ME79139	FL
2	207R00000X	Internal Medicine Physician	ME69293	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74888	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1750418299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 848127
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33084-0127
Country	:	US
Telephone Number	:	954-517-9166
Fax Number	:	954-517-9167

Provider Business Practice Location Address
First Line	:	10000 STIRLING RD
Second Line	:	SUITE 3
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-8067
Country	:	US
Telephone Number	:	954-517-9166
Fax Number	:	954-517-9167

Authorized Official
Title or Position	:	VICE PRESIDENTD
Name	:	DR. MARIE-ALICE LARA
Credential	:	MD
Telephone Number	:	954-517-9166

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/11/2025

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Directions to “PRIMARY CARE MEDICAL SERVICES ” Practice Location

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