Provider Demographics
NPI:1588900864
Name:PRIMARY SPECIALISTS
Entity type:Organization
Organization Name:PRIMARY SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WELCHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:507-238-4949
Mailing Address - Street 1:717 S STATE ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4469
Mailing Address - Country:US
Mailing Address - Phone:507-238-9533
Mailing Address - Fax:507-235-8561
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 800
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-9533
Practice Address - Fax:507-235-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty