=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861822793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY MEDICAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2013
-----------------------------------------------------
Last Update Date | 11/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 CORNERSTONE DR SUITE 105
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27519-8400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-460-7676
-----------------------------------------------------
Fax | 919-460-4605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 CORNERSTONE DR SUITE 105
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27519-8400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-460-7676
-----------------------------------------------------
Fax | 919-460-4605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. MARY T MACKENZIE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 919-460-7676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 9700320
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------