Provider Demographics
NPI:1407482912
Name:MIDEASTERN PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:MIDEASTERN PRIMARY CARE PLLC
Other - Org Name:MIDEASTERN TELEMEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:TOMIKA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:919-867-4996
Mailing Address - Street 1:4804 PAGE CREEK LN STE 115
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8582
Mailing Address - Country:US
Mailing Address - Phone:919-867-4996
Mailing Address - Fax:919-869-1979
Practice Address - Street 1:4804 PAGE CREEK LN STE 115
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8582
Practice Address - Country:US
Practice Address - Phone:919-867-4996
Practice Address - Fax:866-467-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty