Healthcare Provider Details

I. General information

NPI: 1639565674
Provider Name (Legal Business Name): LIMESTONE PRIMARY CARE PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LIMESTONE DR SUITE 5
WILLIAMSVILLE NY
14221-8602
US

IV. Provider business mailing address

18 LIMESTONE DR SUITE 5
WILLIAMSVILLE NY
14221-8602
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1400
  • Fax: 716-632-5316
Mailing address:
  • Phone: 716-632-1400
  • Fax: 716-632-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23018540
License Number StateNY

VIII. Authorized Official

Name: CHERYL ANN REYNARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-632-1400