Provider Demographics
NPI:1134430523
Name:PRIMARY CARE SOLUTIONS INC OF N.C.
Entity type:Organization
Organization Name:PRIMARY CARE SOLUTIONS INC OF N.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-506-9469
Mailing Address - Street 1:5700 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8858
Mailing Address - Country:US
Mailing Address - Phone:704-506-9469
Mailing Address - Fax:
Practice Address - Street 1:158 MCGEHEE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5012
Practice Address - Country:US
Practice Address - Phone:704-506-9469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053535369Medicaid
NC1265574594Medicaid
NC1518009992Medicaid
NC1912223678Medicaid
NC1003144437Medicaid
NC1568505279Medicaid