Provider Demographics
NPI:1982878575
Name:PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type:Organization
Organization Name:PRIME CARE PHYSICIANS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-435-2704
Mailing Address - Street 1:4 ATRIUM DR STE 100
Mailing Address - Street 2:ATTN: CREDENTIALING
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:518-458-2610
Practice Address - Street 1:29 JONES AVE
Practice Address - Street 2:CHATHAM MEDICAL BUILDING
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1136
Practice Address - Country:US
Practice Address - Phone:518-392-8600
Practice Address - Fax:518-392-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02616571Medicaid
NYWNW001Medicare PIN