1043345549 NPI number — PRIMARY HEALTHCARE ASSOCIATES, INC.

Table of content: (NPI 1043345549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043345549 NPI number — PRIMARY HEALTHCARE ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY HEALTHCARE ASSOCIATES, INC.
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:
1043345549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 BELMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44505-2428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-744-0221
Provider Business Mailing Address Fax Number:
330-744-4716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 BELMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44505-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-744-0221
Provider Business Practice Location Address Fax Number:
330-744-4716
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYEK
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-744-0221

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  35043267H , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0400327 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 289425117005 . This is a "MMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0431732 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P006352 . This is a "GATEWAY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000138793 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000139083 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 28942511700 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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