Provider Demographics
NPI:1356809057
Name:PRIVAMEDIS LLC
Entity type:Organization
Organization Name:PRIVAMEDIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MERLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-604-2888
Mailing Address - Street 1:4308 ALTON RD STE 880
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4560
Mailing Address - Country:US
Mailing Address - Phone:305-604-2888
Mailing Address - Fax:305-604-2887
Practice Address - Street 1:4308 ALTON RD STE 880
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4560
Practice Address - Country:US
Practice Address - Phone:305-604-2888
Practice Address - Fax:305-604-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEOtherINTERNAL MEDCINE