Provider Demographics
NPI:1780677229
Name:PRIMAHEALTH IPA LLC
Entity Type:Organization
Organization Name:PRIMAHEALTH IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-471-4484
Mailing Address - Street 1:3710 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6203
Mailing Address - Country:US
Mailing Address - Phone:919-419-2600
Mailing Address - Fax:919-490-8340
Practice Address - Street 1:3710 UNIVERSITY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6203
Practice Address - Country:US
Practice Address - Phone:919-419-2600
Practice Address - Fax:919-490-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization