1922070341 NPI number — PRIMARY CARE ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922070341 NPI number — PRIMARY CARE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE ASSOCIATES LLC
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:
Provider Other Organization Name Type Code:
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:
1922070341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 CHESTNUT ST
Provider Second Line Business Mailing Address:
STE 23
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-787-2800
Provider Business Mailing Address Fax Number:
413-787-2822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 CHESTNUT ST
Provider Second Line Business Practice Location Address:
STE 23
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-787-2800
Provider Business Practice Location Address Fax Number:
413-787-2822
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
PAMELA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-787-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 698206 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3964761007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7013557 . This is a "AETNA TRADITION PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: M18358 . This is a "BC BS OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7247147247141689 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA4074 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3404623 . This is a "AETNA HEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 398206 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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