1902862113 NPI number — PRIMARY CARE HEALTH PARTNERS

Table of content: (NPI 1902862113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902862113 NPI number — PRIMARY CARE HEALTH PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE HEALTH PARTNERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PLATTSBURGH PRIMARY CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902862113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 BLAIR PARK RD
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05495-7586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-860-1145
Provider Business Mailing Address Fax Number:
802-872-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 MARGARET ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-0151
Provider Business Practice Location Address Fax Number:
518-562-2718
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BYCER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
802-860-1145

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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