Provider Demographics
NPI:1982924239
Name:PCA-C
Entity Type:Organization
Organization Name:PCA-C
Other - Org Name:PCA-C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-408-7751
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0957
Mailing Address - Country:US
Mailing Address - Phone:903-408-7751
Mailing Address - Fax:903-408-7802
Practice Address - Street 1:8110 WESLEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-3935
Practice Address - Country:US
Practice Address - Phone:903-408-7751
Practice Address - Fax:903-408-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty