Basic Information
| Provider Information | |||||||||
| NPI: | 1003832403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7111 E 21ST ST N STE A | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672061078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166842851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7111 E 21ST ST N STE A | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672061078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166842851 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOLMES | ||||||||
| AuthorizedOfficialFirstName: | JED | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3166842851 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.