Provider Demographics
NPI:1588707889
Name:PRIMARY CARE ASSOCIATES OF NEW LEBANON, LLC
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF NEW LEBANON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:AL
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-687-1911
Mailing Address - Street 1:550 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-9172
Mailing Address - Country:US
Mailing Address - Phone:937-687-1911
Mailing Address - Fax:937-687-1888
Practice Address - Street 1:550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9172
Practice Address - Country:US
Practice Address - Phone:937-687-1911
Practice Address - Fax:937-687-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067795261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000284750OtherANTHEM BLUE CROSS BLUE SH
OH0317142Medicaid
OH9333471Medicare ID - Type Unspecified
OH000000284750OtherANTHEM BLUE CROSS BLUE SH