1306835855 NPI number — PRIMARY CARE MEDICAL ASSOCIATES, INC.

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 1306835855 NPI number — PRIMARY CARE MEDICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE MEDICAL 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:
DBA PCMA BOYNTON BEACH
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:
1306835855
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:
6056 BOYNTON BEACH BLVD
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33437-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-732-6322
Provider Business Mailing Address Fax Number:
561-739-9981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6056 BOYNTON BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33437-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-732-6322
Provider Business Practice Location Address Fax Number:
561-739-9981
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIRMINGHAM
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-373-7625

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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