Provider Demographics
NPI:1467118059
Name:TANDEM PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:TANDEM PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:MBANUZUE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, PA-C
Authorized Official - Phone:919-321-0418
Mailing Address - Street 1:105 NEWSOM ST STE 106
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 NEWSOM ST STE 106
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2197
Practice Address - Country:US
Practice Address - Phone:704-649-1527
Practice Address - Fax:919-321-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467118059Medicaid
NCNC1105O002OtherMEDICARE