Provider Demographics
NPI:1558149377
Name:PRIMARY CARE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-233-0090
Mailing Address - Street 1:5100 E RANCHO PALOMA DR UNIT 2040
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5189
Mailing Address - Country:US
Mailing Address - Phone:480-233-0090
Mailing Address - Fax:
Practice Address - Street 1:5100 E RANCHO PALOMA DR UNIT 2040
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5189
Practice Address - Country:US
Practice Address - Phone:480-233-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty