Provider Demographics
NPI:1538936133
Name:PLAIN STREET PRIMARYCARE LLC
Entity type:Organization
Organization Name:PLAIN STREET PRIMARYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-282-5040
Mailing Address - Street 1:235 PLAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3241
Mailing Address - Country:US
Mailing Address - Phone:401-272-0127
Mailing Address - Fax:
Practice Address - Street 1:235 PLAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3241
Practice Address - Country:US
Practice Address - Phone:401-272-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty