| Bck Primecare | |
|
1951 Sw 172nd Ave Suite312 Miramar FL 33029-5593 | |
| (954) 320-7999 | |
| (954) 320-7601 |
| Full Name | Bck Primecare |
|---|---|
| Speciality | Clinic/Center |
| Location | 1951 Sw 172nd Ave, Miramar, Florida |
| Authorized Official Name and Position | Vivian Bilasano (MANAGER) |
| Authorized Official Contact | 9543207999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bck Primecare 1951 Sw 172nd Ave Suite312 Miramar FL 33029-5593 Ph: (954) 320-7999 | Bck Primecare 1951 Sw 172nd Ave Suite312 Miramar FL 33029-5593 Ph: (954) 320-7999 |
| NPI Number | 1639559750 |
|---|---|
| Provider Enumeration Date | 06/03/2015 |
| Last Update Date | 01/29/2016 |
| Medicare PECOS PAC ID | 3779890900 |
|---|---|
| Medicare Enrollment ID | O20150921000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639559750 | NPI | - | NPPES |
| 257505100 | Medicaid | FL | |
| 1821002825 | Other | NPI | |
| 1316140262 | Other | FL | NPI |
| 001237900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME 77619 (Florida) | Primary |
| Provider Name | Vivian Blanquisco Bilasano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821002825 PECOS PAC ID: 0749357812 Enrollment ID: I20080916000468 |
| Provider Name | Jorge Konopka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316140262 PECOS PAC ID: 7416094016 Enrollment ID: I20091030000596 |
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