Provider Demographics
NPI:1932225661
Name:PRIMECARE MED CENTER LLC
Entity Type:Organization
Organization Name:PRIMECARE MED CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NNENNA
Authorized Official - Middle Name:IHUOMA
Authorized Official - Last Name:OKIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-592-0062
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2606
Mailing Address - Country:US
Mailing Address - Phone:301-592-0062
Mailing Address - Fax:301-592-0300
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE STE 305
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-592-0062
Practice Address - Fax:301-592-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01921Medicare ID - Type Unspecified