Provider Demographics
NPI:1891102158
Name:PRIMECARE PEDSXPRESS
Entity Type:Organization
Organization Name:PRIMECARE PEDSXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-371-4488
Mailing Address - Street 1:2511 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6466
Mailing Address - Country:US
Mailing Address - Phone:540-786-1200
Mailing Address - Fax:540-786-3195
Practice Address - Street 1:2511 SALEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6466
Practice Address - Country:US
Practice Address - Phone:540-786-1200
Practice Address - Fax:540-786-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty