Healthcare Provider Details

I. General information

NPI: 1265409932
Provider Name (Legal Business Name): PRIMARY HEALTH CONCEPTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 JAKE ALEXANDER BLVD W SUITE 102-103
SALISBURY NC
28147-1162
US

IV. Provider business mailing address

1910 JAKE ALEXANDER BLVD W SUITE 102-103
SALISBURY NC
28147-1162
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-9461
  • Fax: 704-636-4483
Mailing address:
  • Phone: 704-637-9461
  • Fax: 704-636-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC0439
License Number StateNC

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852