Provider Demographics
NPI:1588969539
Name:PRIMARY CARE PEDIATRICS
Entity type:Organization
Organization Name:PRIMARY CARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-753-7337
Mailing Address - Street 1:2380 N 400 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1756
Mailing Address - Country:US
Mailing Address - Phone:435-753-7337
Mailing Address - Fax:435-750-6779
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1756
Practice Address - Country:US
Practice Address - Phone:435-753-7337
Practice Address - Fax:435-750-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1711991205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT029648850018Medicaid
UT529628077035Medicaid