Provider Demographics
NPI:1407985971
Name:DAVID E ROSS, JR, MD,PC
Entity Type:Organization
Organization Name:DAVID E ROSS, JR, MD,PC
Other - Org Name:DBA PRIMARY CARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:219-886-4788
Mailing Address - Street 1:PO BOX 4787
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-0787
Mailing Address - Country:US
Mailing Address - Phone:219-886-4788
Mailing Address - Fax:219-886-4106
Practice Address - Street 1:1619 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1506
Practice Address - Country:US
Practice Address - Phone:219-886-4788
Practice Address - Fax:219-886-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212420AMedicaid
IN100212420AMedicaid
IN100212420AMedicaid