Provider Demographics
NPI:1184782724
Name:PRIMARY CARE ASSOCIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY MANAGMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-9444
Mailing Address - Street 1:1635 LAKE SAN MARCOS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4698
Mailing Address - Country:US
Mailing Address - Phone:760-471-9444
Mailing Address - Fax:760-471-4886
Practice Address - Street 1:1635 LAKE SAN MARCOS DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4698
Practice Address - Country:US
Practice Address - Phone:760-471-9444
Practice Address - Fax:760-471-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization