Provider Demographics
NPI:1396926697
Name:PRIMED PARTNERS, LLC
Entity type:Organization
Organization Name:PRIMED PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LUCIBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-817-7886
Mailing Address - Street 1:5011 N OCEAN BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OCEAN RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7355
Mailing Address - Country:US
Mailing Address - Phone:877-817-7886
Mailing Address - Fax:877-817-7886
Practice Address - Street 1:5011 N OCEAN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:OCEAN RIDGE
Practice Address - State:FL
Practice Address - Zip Code:33435-7355
Practice Address - Country:US
Practice Address - Phone:877-817-7886
Practice Address - Fax:877-817-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center