Provider Demographics
NPI:1992353619
Name:PRIME CARE PROVIDERS LLC
Entity type:Organization
Organization Name:PRIME CARE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-254-4885
Mailing Address - Street 1:1013 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2544
Mailing Address - Country:US
Mailing Address - Phone:814-254-4885
Mailing Address - Fax:
Practice Address - Street 1:1013 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2544
Practice Address - Country:US
Practice Address - Phone:814-254-4885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty