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NPI Code Detail

MEDICARE: PRIMARY CARE SERVICES

MEDICARE: PRIMARY CARE SERVICES
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
1363AM0700XMedical Physician Assistant
2363LP2300XPrimary Care Nurse Practitioner
3207RG0300XGeriatric Medicine (Internal Medicine) Physician
4363LF0000XFamily Nurse Practitioner
5207Q00000XFamily Medicine Physician
6207QA0505XAdult Medicine Physician
7207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1962804955
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE SERVICES
Provider Business Mailing Address
First Line : 1034 GROVE ST
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-2945
Country : US
Telephone Number : 814-373-4298
Fax Number : 814-724-2196
Provider Business Practice Location Address
First Line : 991 PARK AVE
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3344
Country : US
Telephone Number : 814-373-4298
Fax Number : 814-724-2196
Authorized Official
Title or Position : CONTROLLER
Name : CORY JACKSON
Credential :
Telephone Number : 814-333-5766
Provider Enumeration Date : 09/22/2014
Last Update Date : 04/24/2026

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Directions to “PRIMARY CARE SERVICES ” Practice Location

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