Provider Demographics
NPI:1003972951
Name:PRIMARY CARE ASSOCIATES OF WILLIAMSON
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF WILLIAMSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-237-0053
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-0053
Mailing Address - Fax:606-237-8485
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-0053
Practice Address - Fax:606-237-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010395000Medicaid
WV0010395000Medicaid