MEDICARE: PRIMECARE MEDICAL GROUP 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942168638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	695 TRUMAN HWY
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-3552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 TRUMAN HWY
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-3552
Country	:	US
Telephone Number	:	857-350-6806
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLIFTON LOUIS
Credential	:
Telephone Number	:	857-350-6806

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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