Provider Demographics
NPI:1558465146
Name:PRIMECARE MEDICAL LLP
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CECI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-327-1908
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0218
Mailing Address - Country:US
Mailing Address - Phone:860-925-6446
Mailing Address - Fax:860-925-6120
Practice Address - Street 1:80 MILL RIVER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3733
Practice Address - Country:US
Practice Address - Phone:203-327-1080
Practice Address - Fax:203-348-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004191293Medicaid
CT004191293Medicaid
CI3567Medicare PIN