Provider Demographics
NPI:1104905728
Name:PRIMACARE MEDICAL CENTERS
Entity type:Organization
Organization Name:PRIMACARE MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:214-572-1124
Mailing Address - Street 1:11910 GREENVILLE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3596
Mailing Address - Country:US
Mailing Address - Phone:214-572-1124
Mailing Address - Fax:214-572-7724
Practice Address - Street 1:11910 GREENVILLE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-572-1124
Practice Address - Fax:214-572-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty