Provider Demographics
NPI:1578872214
Name:PRI-MED CARE INC
Entity Type:Organization
Organization Name:PRI-MED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MONSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-836-4473
Mailing Address - Street 1:4479 RTE 136
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6413
Mailing Address - Country:US
Mailing Address - Phone:724-836-4473
Mailing Address - Fax:724-836-3835
Practice Address - Street 1:4479 RTE 136
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6413
Practice Address - Country:US
Practice Address - Phone:724-836-4473
Practice Address - Fax:724-836-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-0524125-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1490757001Medicaid
PA769252Medicare UPIN
PA1490757001Medicaid