1992925986 NPI number — PRIME CARE PHYSICIANS, P.L.L.C.

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 1992925986 NPI number — PRIME CARE PHYSICIANS, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME CARE PHYSICIANS, P.L.L.C.
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:
GLENS FALLS ASSOCIATES IN CARDIOLOGY
Provider Other Organization Name Type Code:
3
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:
1992925986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 ATRIUM DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12205-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-435-2704
Provider Business Mailing Address Fax Number:
518-458-2610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 QUAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-793-1083
Provider Business Practice Location Address Fax Number:
518-793-0953
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHALEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATION
Authorized Official Telephone Number:
518-435-2704

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: 54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: 54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 54964 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02616571 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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