Provider Demographics
NPI:1124013040
Name:PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type:Organization
Organization Name:PRIME CARE PHYSICIANS, P.L.L.C.
Other - Org Name:HEALTH STREAM MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAVANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-758-6046
Mailing Address - Street 1:17 GLENN POND ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1824
Mailing Address - Country:US
Mailing Address - Phone:845-758-6046
Mailing Address - Fax:845-758-6051
Practice Address - Street 1:17 GLENN POND ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1824
Practice Address - Country:US
Practice Address - Phone:845-758-6046
Practice Address - Fax:845-758-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02616571Medicaid
NY305071Medicare PIN
NYWNW001Medicare PIN