Provider Demographics
NPI:1568628766
Name:PRIMARY HEALTH CARE ASSOCIATES PLLC
Entity type:Organization
Organization Name:PRIMARY HEALTH CARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ORVIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-269-6620
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0747
Mailing Address - Country:US
Mailing Address - Phone:304-269-6620
Mailing Address - Fax:
Practice Address - Street 1:25 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2128
Practice Address - Country:US
Practice Address - Phone:304-269-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055675000Medicaid
WV9377721Medicare PIN
WVA72000Medicare UPIN