Provider Demographics
NPI:1821436155
Name:PRIME CARE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAZLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-663-3587
Mailing Address - Street 1:2220 MT VERNON LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4257
Mailing Address - Country:US
Mailing Address - Phone:334-821-6287
Mailing Address - Fax:
Practice Address - Street 1:203 W LEE ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1719
Practice Address - Country:US
Practice Address - Phone:334-663-3587
Practice Address - Fax:334-821-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care