Provider Demographics
NPI:1316058092
Name:ZEBULON PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:ZEBULON PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-433-0720
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:RACCOON
Mailing Address - State:KY
Mailing Address - Zip Code:41557-0203
Mailing Address - Country:US
Mailing Address - Phone:606-432-2887
Mailing Address - Fax:
Practice Address - Street 1:774 RAMEY FRK
Practice Address - Street 2:
Practice Address - City:RACCOON
Practice Address - State:KY
Practice Address - Zip Code:41557-8356
Practice Address - Country:US
Practice Address - Phone:606-432-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37264207R00000X
KY3774P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty