Provider Demographics
NPI:1538872528
Name:PRIMARY MEDICAL CARE CENTER IV, INC.
Entity type:Organization
Organization Name:PRIMARY MEDICAL CARE CENTER IV, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-GLUADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-345-1369
Mailing Address - Street 1:11500 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2506
Mailing Address - Country:US
Mailing Address - Phone:561-250-0000
Mailing Address - Fax:888-365-3056
Practice Address - Street 1:1233 45TH ST STE B4
Practice Address - Street 2:
Practice Address - City:MANGONIA PARK
Practice Address - State:FL
Practice Address - Zip Code:33407-2162
Practice Address - Country:US
Practice Address - Phone:561-250-0000
Practice Address - Fax:888-365-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center