Provider Demographics
NPI:1538237292
Name:PRIMARY CARE ASSOCIATES OF SEPA
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF SEPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLEMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-237-5810
Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 3003
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-237-5810
Mailing Address - Fax:610-237-5826
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3003
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-5810
Practice Address - Fax:610-237-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005851L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52753Medicare UPIN