Provider Demographics
NPI:1548538473
Name:PRIMARY CARE PARTNERS
Entity type:Organization
Organization Name:PRIMARY CARE PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:401-691-6000
Mailing Address - Street 1:2756 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3003
Mailing Address - Country:US
Mailing Address - Phone:401-691-6000
Mailing Address - Fax:401-738-7718
Practice Address - Street 1:2756 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3003
Practice Address - Country:US
Practice Address - Phone:401-691-6000
Practice Address - Fax:401-738-7718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KENT CENTER FOR HUMAN & ORGANIZATIONAL DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-07
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITH87001Medicaid
RITH87001Medicaid