Provider Demographics
NPI:1558951392
Name:PRIMARY CONVENIENT CARE CORPORATION
Entity Type:Organization
Organization Name:PRIMARY CONVENIENT CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:330-853-7086
Mailing Address - Street 1:3763 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44445-0001
Mailing Address - Country:US
Mailing Address - Phone:330-420-2025
Mailing Address - Fax:330-967-4444
Practice Address - Street 1:3763 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW WATERFORD
Practice Address - State:OH
Practice Address - Zip Code:44445-0001
Practice Address - Country:US
Practice Address - Phone:330-420-2025
Practice Address - Fax:330-967-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care