Provider Demographics
NPI:1700131604
Name:PRIME CARE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:PRIME CARE PHYSICIANS, PLLC
Other - Org Name:NORTHEAST ADVANCED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:518-435-2704
Mailing Address - Street 1:4 ATRIUM DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1441
Mailing Address - Country:US
Mailing Address - Phone:518-435-2740
Mailing Address - Fax:518-649-4025
Practice Address - Street 1:279 TROY RD
Practice Address - Street 2:ROUTE 4
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9499
Practice Address - Country:US
Practice Address - Phone:518-880-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02616571Medicaid
VT1011152Medicaid
VT1011152Medicaid
NYBA0251Medicare PIN