Provider Demographics
NPI:1417005919
Name:PRIMARY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PRIMARY HEALTH CARE, INC.
Other - Org Name:PRIMARY HEALTH CARE-UNIVERSITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-248-1441
Mailing Address - Street 1:1200 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2355
Mailing Address - Country:US
Mailing Address - Phone:515-248-1447
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:1200 UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2355
Practice Address - Country:US
Practice Address - Phone:515-248-1500
Practice Address - Fax:515-248-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IANA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0199109Medicaid
IA37399OtherWELLMARK BCBS
IAI9909Medicare PIN
IA0199109Medicaid