Provider Demographics
NPI:1528073368
Name:PRIMARY CARE PHYSICIAN ASSOCIATES, INC.
Entity type:Organization
Organization Name:PRIMARY CARE PHYSICIAN ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-499-9944
Mailing Address - Street 1:3951 CONVENIENCE CIR NW STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2686
Mailing Address - Country:US
Mailing Address - Phone:330-499-9944
Mailing Address - Fax:330-499-3056
Practice Address - Street 1:3951 CONVENIENCE CIR NW STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2686
Practice Address - Country:US
Practice Address - Phone:330-499-9944
Practice Address - Fax:330-499-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277150Medicaid
OHPR9285241Medicare PIN