Provider Demographics
NPI:1992141600
Name:PRIMARY MEDICAL CARE, INC.
Entity type:Organization
Organization Name:PRIMARY MEDICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-997-1229
Mailing Address - Street 1:785 ROCKDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-997-1229
Mailing Address - Fax:508-997-1220
Practice Address - Street 1:785 ROCKDALE AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-997-1229
Practice Address - Fax:508-997-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2072254Medicaid
MAK11214Medicare PIN
MAB76965Medicare UPIN