Provider Demographics
NPI:1174684112
Name:PRIMARY MEDICAL ASSOCIATION, P.A.
Entity Type:Organization
Organization Name:PRIMARY MEDICAL ASSOCIATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-324-7777
Mailing Address - Street 1:1410 SNYDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7721
Mailing Address - Country:US
Mailing Address - Phone:803-324-7777
Mailing Address - Fax:803-324-8787
Practice Address - Street 1:1787 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1101
Practice Address - Country:US
Practice Address - Phone:803-324-7777
Practice Address - Fax:803-324-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2808Medicaid
SCG41904Medicare UPIN
SCG419040282Medicare ID - Type Unspecified