Provider Demographics
NPI:1588731764
Name:PRIMARY CARE ASSOCIATES LTD
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-484-0042
Mailing Address - Street 1:6840 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3441
Mailing Address - Country:US
Mailing Address - Phone:708-484-0042
Mailing Address - Fax:708-749-5489
Practice Address - Street 1:6840 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3441
Practice Address - Country:US
Practice Address - Phone:708-484-0042
Practice Address - Fax:708-749-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty