Healthcare Provider Details

I. General information

NPI: 1962896894
Provider Name (Legal Business Name): PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5052 S JONES BLVD SUITE 110
LAS VEGAS NV
89118-0538
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 800-276-7021
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number6769
License Number StateNV

VIII. Authorized Official

Name: THOMAS C YEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-276-7021