Provider Demographics
NPI:1790953719
Name:PRIMECARE PHYSICIANS MEDICAL GRP
Entity Type:Organization
Organization Name:PRIMECARE PHYSICIANS MEDICAL GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-599-1555
Mailing Address - Street 1:9900 STOCKDALE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3634
Mailing Address - Country:US
Mailing Address - Phone:661-599-1555
Mailing Address - Fax:661-000-0000
Practice Address - Street 1:9900 STOCKDALE HWY STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3634
Practice Address - Country:US
Practice Address - Phone:661-599-1555
Practice Address - Fax:661-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211350OtherBLUE SHIELD UPIN
CA1902954738OtherNPI
CADC0211350OtherBLUESHIELD
CA1770580912OtherNPI
CADC0211350OtherBLUESHIELD
CA00A536611Medicare PIN
CA00A53661Medicare UPIN
CA1770580912OtherNPI