Provider Demographics
NPI:1801428487
Name:PRIMARY MEDICAL CARE AT THE CROSSROADS, PLLC
Entity type:Organization
Organization Name:PRIMARY MEDICAL CARE AT THE CROSSROADS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:919-889-6601
Mailing Address - Street 1:58 OLD ROBERTS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8047
Mailing Address - Country:US
Mailing Address - Phone:919-889-6601
Mailing Address - Fax:
Practice Address - Street 1:58 OLD ROBERTS RD STE 102
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8047
Practice Address - Country:US
Practice Address - Phone:919-889-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty