Provider Demographics
NPI:1508036096
Name:MARCELO R PEREZ-MONTES MD PA
Entity Type:Organization
Organization Name:MARCELO R PEREZ-MONTES MD PA
Other - Org Name:PRIMECARE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ-MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-727-1709
Mailing Address - Street 1:4459 ARENDELL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2795
Mailing Address - Country:US
Mailing Address - Phone:252-727-1709
Mailing Address - Fax:252-727-1710
Practice Address - Street 1:4459 ARENDELL ST
Practice Address - Street 2:STE 1
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2795
Practice Address - Country:US
Practice Address - Phone:252-727-1709
Practice Address - Fax:252-727-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900539Medicaid
NC5900539Medicaid
NC2346144Medicare PIN