Provider Demographics
NPI:1700976701
Name:PRIME CARE PHYSICIANS PA
Entity Type:Organization
Organization Name:PRIME CARE PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-735-7580
Mailing Address - Street 1:2607 MEDICAL OFFICE PL STE B
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9437
Mailing Address - Country:US
Mailing Address - Phone:919-735-7580
Mailing Address - Fax:919-735-1475
Practice Address - Street 1:2607 MEDICAL OFFICE PL STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9437
Practice Address - Country:US
Practice Address - Phone:919-735-7580
Practice Address - Fax:919-735-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790286HMedicaid
NC790286HMedicaid