MEDICARE: A PRIMARY CARE PLLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1366114118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	5060 N 19TH AVE STE 406-12
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:	480-519-6285
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 N 19TH AVE STE 406-12
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:	480-519-6285
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK WESLEY COLEMAN
Credential	:	FNP-BC
Telephone Number	:	480-519-6285

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	12/05/2025

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