Provider Demographics
NPI:1609084375
Name:PRIMECARE PHYSICIANS OF WEST CENTRAL OHIO, INC
Entity Type:Organization
Organization Name:PRIMECARE PHYSICIANS OF WEST CENTRAL OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-492-8431
Mailing Address - Street 1:1205 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8144
Mailing Address - Country:US
Mailing Address - Phone:937-492-8431
Mailing Address - Fax:937-498-5126
Practice Address - Street 1:1205 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8144
Practice Address - Country:US
Practice Address - Phone:937-492-8431
Practice Address - Fax:937-498-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9929101Medicare ID - Type Unspecified