MEDICARE: PRIMARY MEDICAL SPECIALISTS, INC

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	35043902	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110248769	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000262223	OTHER	OH	BLUECROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356530018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MEDICAL SPECIALISTS, INC

Provider Business Mailing Address
First Line	:	1611 27TH ST
Second Line	:	FULTON BLDG. SUITE 101
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-353-4143
Fax Number	:	740-353-1714

Provider Business Practice Location Address
First Line	:	1611 27TH ST
Second Line	:	FULTON BLDG. SUITE 101
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-353-4143
Fax Number	:	740-353-1714

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUZANN M BONZO
Credential	:	MD
Telephone Number	:	740-353-4143

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	07/01/2010

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Directions to “PRIMARY MEDICAL SPECIALISTS, INC ” Practice Location

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