Provider Demographics
NPI:1407482912
Name:MIDEASTERN PRIMARY CARE PLLC
Entity type:Organization
Organization Name:MIDEASTERN PRIMARY CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:TOMIKA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:919-867-1937
Mailing Address - Street 1:150 PRESTON EXECUTIVE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8485
Mailing Address - Country:US
Mailing Address - Phone:919-867-1937
Mailing Address - Fax:919-551-7510
Practice Address - Street 1:1330 SE MAYNARD RD STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3628
Practice Address - Country:US
Practice Address - Phone:919-867-1937
Practice Address - Fax:919-551-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty