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General NPI Number Information
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NPI Number | 1891980959
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Entity Type | Organization
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Legal Business Name | PHYSICIAN'S PRIME CARE CENTRE
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 2908 N HERRITAGE ST
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City | KINSTON
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State | NC
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Zip | 28501-1580
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Country | US
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Telephone | 252-523-3111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1441
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City | KINSTON
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State | NC
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Zip | 28503-1441
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Country | US
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Telephone | 252-523-3111
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Fax | 252-523-9572
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN KIM
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Credential | MD
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Telephone | 252-523-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 9400542
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License Number State | NC
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