Organization Name: | PRIMARY CARE ONE, P.C. |
NPI Number: | 1023116464 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLENDORA G GREENE (DIRECTOR/OWNER) |
Mailing Address: | 850 S Health Pkwy Three Rivers |
State: | MI US |
Postal Code: | 490938358 |
Phone Number: | 2692795240 |
Fax Number: | 2692739060 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 09/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |