MEDICARE: PRIMARY CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LA0401X	Addiction Medicine (Anesthesiology) Physician	6769	NV

General Provider Information

NPI Number	:	1962896894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 34120
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89533-4120
Country	:	US
Telephone Number	:	775-747-5050
Fax Number	:	775-747-5005

Provider Business Practice Location Address
First Line	:	5052 S JONES BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-0538
Country	:	US
Telephone Number	:	800-276-7021
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS C YEE
Credential	:	M.D.
Telephone Number	:	800-276-7021

Provider Enumeration Date	:	03/28/2015
Last Update Date	:	07/20/2015

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