MEDICARE: PRIMARY MEDICAL ASSOCIATION, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174684112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MEDICAL ASSOCIATION, P.A.

Provider Business Mailing Address
First Line	:	1410 SNYDER ST
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-7721
Country	:	US
Telephone Number	:	803-324-7777
Fax Number	:	803-324-8787

Provider Business Practice Location Address
First Line	:	1787 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1101
Country	:	US
Telephone Number	:	803-324-7777
Fax Number	:	803-324-8787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSHIL KUMAR DAS
Credential	:	MD
Telephone Number	:	803-324-7777

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/23/2012

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