Provider Demographics
NPI:1548669013
Name:PRIMARY HEALTH PHYSICIANS GROUP, LLC
Entity type:Organization
Organization Name:PRIMARY HEALTH PHYSICIANS GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-403-2219
Mailing Address - Street 1:655 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2522
Mailing Address - Country:US
Mailing Address - Phone:305-403-2219
Mailing Address - Fax:786-517-3620
Practice Address - Street 1:655 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2522
Practice Address - Country:US
Practice Address - Phone:305-403-2219
Practice Address - Fax:786-517-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization