Provider Demographics
NPI:1891980959
Name:PHYSICIAN'S PRIME CARE CENTRE
Entity Type:Organization
Organization Name:PHYSICIAN'S PRIME CARE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-523-3111
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1441
Mailing Address - Country:US
Mailing Address - Phone:252-523-3111
Mailing Address - Fax:252-523-9572
Practice Address - Street 1:2908 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1580
Practice Address - Country:US
Practice Address - Phone:252-523-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400542261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013G5OtherBCBS
NC5906469Medicaid
NC=========OtherACS BENEFIT SERVICES, INC
NC013G5OtherBCBS
NC=========OtherAETNA
NC========= 0004OtherCIGNA HEALTHCARE
NC5906469Medicaid
NC013G5OtherBCBS