1811388242 NPI number — PRIMARY HEALTH CARE SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811388242 NPI number — PRIMARY HEALTH CARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY HEALTH CARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811388242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12741 SW 42ND ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-505-6178
Provider Business Mailing Address Fax Number:
786-504-9672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12741 SW 42ND ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-505-6178
Provider Business Practice Location Address Fax Number:
786-504-9672
Provider Enumeration Date:
02/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUDHRY
Authorized Official First Name:
ABID
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
786-505-6178

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  ME100581 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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