Provider Demographics
NPI:1922291384
Name:PHYSICIAN'S PRIMARY CARE CENTER, INC.
Entity Type:Organization
Organization Name:PHYSICIAN'S PRIMARY CARE CENTER, INC.
Other - Org Name:PPCC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-414-8440
Mailing Address - Street 1:400 E 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-2474
Mailing Address - Country:US
Mailing Address - Phone:208-414-8440
Mailing Address - Fax:208-414-8442
Practice Address - Street 1:400 E 7TH ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2474
Practice Address - Country:US
Practice Address - Phone:208-414-8440
Practice Address - Fax:208-414-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13755034Medicare UPIN