Provider Demographics
NPI:1225224132
Name:PRIMARY NURSE PRACTITIONER INC
Entity Type:Organization
Organization Name:PRIMARY NURSE PRACTITIONER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIRC
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:440-392-9550
Mailing Address - Street 1:PO BOX 74736
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4194
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:5301 E HEISLEY RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-392-9550
Practice Address - Fax:440-392-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG4680OtherMEDICARE RAILROAD GROUP PIN NUMBER
OH2964501Medicaid
OHDG4680OtherMEDICARE RAILROAD GROUP PIN NUMBER