Provider Demographics
NPI:1629248257
Name:PRIMARY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PRIMARY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAEJONG
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-354-8111
Mailing Address - Street 1:7360 MCWHORTER PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5633
Mailing Address - Country:US
Mailing Address - Phone:703-354-8111
Mailing Address - Fax:
Practice Address - Street 1:7360 MCWHORTER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5633
Practice Address - Country:US
Practice Address - Phone:703-354-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG771-0001OtherBLUE CROSS BLUE SHIELD
VA274262OtherANTHEM
VAG00795Medicare PIN