MEDICARE: PRIMARY CARE ASSOCIATES

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	35-05-9111	OH

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	:	1508962564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	602 PARMALEE AVE
Second Line	:	SUITE 400
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1653
Country	:	US
Telephone Number	:	330-747-8611
Fax Number	:	330-747-8027

Provider Business Practice Location Address
First Line	:	602 PARMALEE AVE
Second Line	:	SUITE 400
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1653
Country	:	US
Telephone Number	:	330-747-8611
Fax Number	:	330-747-8027

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANTUCCIO RICCIARDI
Credential	:	MD
Telephone Number	:	330-747-8611

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/07/2010

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Directions to “PRIMARY CARE ASSOCIATES ” Practice Location

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