Provider Demographics
NPI:1285689216
Name:PRIMARY CARE ASSOCIATES PA
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-873-1770
Mailing Address - Street 1:8483 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 19
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3360
Mailing Address - Country:US
Mailing Address - Phone:772-873-1770
Mailing Address - Fax:772-873-1313
Practice Address - Street 1:8483 S US HIGHWAY 1
Practice Address - Street 2:SUITE 19
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3360
Practice Address - Country:US
Practice Address - Phone:772-873-1770
Practice Address - Fax:772-873-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty