Healthcare Provider Details

I. General information

NPI: 1588707889
Provider Name (Legal Business Name): PRIMARY CARE ASSOCIATES OF NEW LEBANON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W MAIN ST
NEW LEBANON OH
45345-9172
US

IV. Provider business mailing address

550 W MAIN ST
NEW LEBANON OH
45345-9172
US

V. Phone/Fax

Practice location:
  • Phone: 937-687-1911
  • Fax: 937-687-1888
Mailing address:
  • Phone: 937-687-1911
  • Fax: 937-687-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number35067795
License Number StateOH

VIII. Authorized Official

Name: DR. DENNIS AL BINGHAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 937-687-1911