Provider Demographics
NPI:1790790574
Name:PRIMECARE FAMILY MEDICINE
Entity Type:Organization
Organization Name:PRIMECARE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-631-3640
Mailing Address - Street 1:20 BEACON HILL DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2402
Mailing Address - Country:US
Mailing Address - Phone:914-591-6888
Mailing Address - Fax:914-591-7938
Practice Address - Street 1:20 BEACON HILL DR STE 2B
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2402
Practice Address - Country:US
Practice Address - Phone:914-591-6888
Practice Address - Fax:914-591-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694682Medicaid
NYP620018OtherOXFORD
NY66760OtherBLUE CROSS BLUE SHIELD
NYOD1520OtherHEALTHNET
NY01694682Medicaid
NYG44770Medicare UPIN