Healthcare Provider Details

I. General information

NPI: 1134348170
Provider Name (Legal Business Name): PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD MEDICAL IMAGING DEPARTMENT
ALBANY NY
12208-1707
US

IV. Provider business mailing address

4 ATRIUM DR SUITE 100
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1852
  • Fax: 518-525-5187
Mailing address:
  • Phone: 518-435-2704
  • Fax: 518-458-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number54964
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number54964
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number54964
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54964
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number54964
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL WHALEN
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 518-435-2704