Healthcare Provider Details

I. General information

NPI: 1255897625
Provider Name (Legal Business Name): PRIMARY CARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

1000 S 12TH ST
MURRAY KY
42071-9303
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax:
Mailing address:
  • Phone: 270-759-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C HUGHES
Title or Position: MANAGING PARTNER
Credential:
Phone: 270-759-9200