Provider Demographics
NPI:1225444243
Name:PRIMARY MEDICAL CENTER AND WALK-IN LLC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL CENTER AND WALK-IN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-434-0022
Mailing Address - Street 1:684 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1405
Mailing Address - Country:US
Mailing Address - Phone:401-434-0022
Mailing Address - Fax:401-434-6111
Practice Address - Street 1:684 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1405
Practice Address - Country:US
Practice Address - Phone:401-434-0022
Practice Address - Fax:401-434-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty