Provider Demographics
NPI:1548658438
Name:PRIME CARE HOUSE CALLS PC
Entity type:Organization
Organization Name:PRIME CARE HOUSE CALLS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:NETTINA
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:443-280-3480
Mailing Address - Street 1:2760 WYNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9519
Mailing Address - Country:US
Mailing Address - Phone:443-280-3480
Mailing Address - Fax:
Practice Address - Street 1:2760 WYNFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST FRIENDSHIP
Practice Address - State:MD
Practice Address - Zip Code:21794-9519
Practice Address - Country:US
Practice Address - Phone:443-280-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109061261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care