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General NPI Number Information
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NPI Number | 1962804955
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE SERVICES
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 991 PARK AVE
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City | MEADVILLE
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State | PA
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Zip | 16335-3344
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Country | US
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Telephone | 814-373-4298
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Fax | 814-724-2196
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Provider Business Mailing Address
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Address Line | 1034 GROVE ST
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City | MEADVILLE
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State | PA
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Zip | 16335-2945
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Country | US
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Telephone | 814-373-4298
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Fax | 814-724-2196
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Authorized Official
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Title or Position | CONTROLLER
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Name | CORY JACKSON
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Credential |
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Telephone | 814-333-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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