Provider Demographics
NPI:1891078606
Name:PRIMARY CHOICE MEDICAL, PA
Entity Type:Organization
Organization Name:PRIMARY CHOICE MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-990-1825
Mailing Address - Street 1:9 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6621
Mailing Address - Country:US
Mailing Address - Phone:864-990-1825
Mailing Address - Fax:864-284-0856
Practice Address - Street 1:9 BUENA VISTA WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6621
Practice Address - Country:US
Practice Address - Phone:864-990-1825
Practice Address - Fax:864-284-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF16694Medicare UPIN
SCA549Medicare PIN