Provider Demographics
NPI:1164559795
Name:PRIME MEDICAL ASSOCIATES OF NORTH
Entity Type:Organization
Organization Name:PRIME MEDICAL ASSOCIATES OF NORTH
Other - Org Name:NORTH RALEIGH INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:YACONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-876-7200
Mailing Address - Street 1:PO BOX 99279
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9279
Mailing Address - Country:US
Mailing Address - Phone:919-803-1417
Mailing Address - Fax:919-803-1418
Practice Address - Street 1:2301 REXWOODS DR
Practice Address - Street 2:SUITE 118
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3366
Practice Address - Country:US
Practice Address - Phone:919-803-1417
Practice Address - Fax:919-803-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01110207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0286LOtherBLUE CROSS BLUE SHIELD NC
B37264Medicare UPIN
NC0286LOtherBLUE CROSS BLUE SHIELD NC