Provider Demographics
NPI:1578676102
Name:PRIMECARE OCCUPATIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:PRIMECARE OCCUPATIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-836-0004
Mailing Address - Street 1:301 WESTGATE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2962
Mailing Address - Country:US
Mailing Address - Phone:334-836-0004
Mailing Address - Fax:334-671-0220
Practice Address - Street 1:301 WESTGATE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2962
Practice Address - Country:US
Practice Address - Phone:334-836-0004
Practice Address - Fax:334-671-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX ID #