Provider Demographics
NPI:1053749887
Name:PRIMARY CARE AGENCY, LLC
Entity type:Organization
Organization Name:PRIMARY CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZINOVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRALYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-924-4118
Mailing Address - Street 1:1680 MICHIGAN AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2538
Mailing Address - Country:US
Mailing Address - Phone:305-924-4118
Mailing Address - Fax:847-919-3507
Practice Address - Street 1:1680 MICHIGAN AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2538
Practice Address - Country:US
Practice Address - Phone:305-924-4118
Practice Address - Fax:847-919-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization