Provider Demographics
NPI:1104251081
Name:PRIMENET MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PRIMENET MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-1220
Mailing Address - Street 1:1100 S STATE ROAD 7
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4033
Mailing Address - Country:US
Mailing Address - Phone:954-984-8000
Mailing Address - Fax:954-984-8811
Practice Address - Street 1:1100 S STATE ROAD 7
Practice Address - Street 2:SUITE 104
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-4033
Practice Address - Country:US
Practice Address - Phone:954-984-8000
Practice Address - Fax:954-984-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370428900Medicaid
FL254724400Medicaid
FL277530100Medicaid
FL045341200Medicaid
FL003094200Medicaid
FLH31988Medicare UPIN
FL00237Medicare UPIN
FL254724400Medicaid
FLG73108Medicare UPIN
FLE34018Medicare UPIN