MEDICARE: PRIMARY MEDICAL, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1407869886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1413 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6012
Country	:	US
Telephone Number	:	843-238-5654
Fax Number	:	843-238-1624

Provider Business Practice Location Address
First Line	:	1413 HIGHWAY 17 N
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6012
Country	:	US
Telephone Number	:	843-238-5654
Fax Number	:	843-238-1624

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES MARVIN VEST
Credential	:	M.D.
Telephone Number	:	843-238-5654

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/15/2007

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