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General NPI Number Information
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NPI Number | 1619914439
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE ASSOCIATES PC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1935 W MAIN ST
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City | SALEM
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State | VA
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Zip | 24153-3109
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Country | US
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Telephone | 540-302-0192
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Fax | 540-302-0193
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Provider Business Mailing Address
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Address Line | 1935 W MAIN ST PO BOX 1568
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City | SALEM
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State | VA
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Zip | 24153-3109
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Country | US
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Telephone | 540-302-0192
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Fax | 540-302-0193
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN J POLVERINO
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Credential | D.O.
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Telephone | 540-302-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | VA
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