Provider Demographics
NPI:1720803190
Name:INCREDICARE PRIMARY CARE INC
Entity type:Organization
Organization Name:INCREDICARE PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:725-867-8144
Mailing Address - Street 1:5510 S FORT APACHE RD # 465
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7700
Mailing Address - Country:US
Mailing Address - Phone:702-250-6106
Mailing Address - Fax:
Practice Address - Street 1:5510 S FORT APACHE RD # 465
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7700
Practice Address - Country:US
Practice Address - Phone:725-867-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty