Provider Demographics
NPI:1720459175
Name:FLORIDA PRIMARY HEALTH LLC
Entity type:Organization
Organization Name:FLORIDA PRIMARY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRECIADO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:954-606-5656
Mailing Address - Street 1:5890 STIRLING RD
Mailing Address - Street 2:SUITE 5/6
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1542
Mailing Address - Country:US
Mailing Address - Phone:954-606-5656
Mailing Address - Fax:954-606-5657
Practice Address - Street 1:5890 STIRLING RD
Practice Address - Street 2:SUITE 5/6
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1542
Practice Address - Country:US
Practice Address - Phone:954-606-5656
Practice Address - Fax:954-606-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10450261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 11100OtherHCC UNIT