Provider Demographics
NPI:1063547784
Name:VS PRIMO HEALTH CARE P A
Entity type:Organization
Organization Name:VS PRIMO HEALTH CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIORTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-751-7113
Mailing Address - Street 1:840 EXECUTIVE LN STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3519
Mailing Address - Country:US
Mailing Address - Phone:321-751-7113
Mailing Address - Fax:321-751-7114
Practice Address - Street 1:840 EXECUTIVE LN STE 110
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3519
Practice Address - Country:US
Practice Address - Phone:321-751-7113
Practice Address - Fax:321-751-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9106Medicare PIN
FLI47477Medicare UPIN