Healthcare Provider Details

I. General information

NPI: 1982367082
Provider Name (Legal Business Name): PRIMARY COMMUNITY CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 E MORGAN AVE STE A
EVANSVILLE IN
47711-4471
US

IV. Provider business mailing address

3116 E MORGAN AVE STE A
EVANSVILLE IN
47711-4471
US

V. Phone/Fax

Practice location:
  • Phone: 812-598-6819
  • Fax:
Mailing address:
  • Phone: 812-598-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME REDMAN
Title or Position: PRESIDENT
Credential: NP-C, CCM
Phone: 812-598-6819