| Prime Care Family Practice, P.c. | |
|
4700 Puddledock Road Suite 300 Prince George VA 23875-1268 | |
| (804) 526-1111 | |
| (804) 526-8363 |
| Full Name | Prime Care Family Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4700 Puddledock Road, Prince George, Virginia |
| Authorized Official Name and Position | Deidra F. Mann (PRACTICE MANAGER) |
| Authorized Official Contact | 8045261111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Care Family Practice, P.c. 4700 Puddledock Road Suite 300 Prince George VA 23875-1268 Ph: (804) 526-1111 | Prime Care Family Practice, P.c. 4700 Puddledock Road Suite 300 Prince George VA 23875-1268 Ph: (804) 526-1111 |
| NPI Number | 1881629384 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 07/27/2015 |
| Medicare PECOS PAC ID | 5799738035 |
|---|---|
| Medicare Enrollment ID | O20050225000611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881629384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tami Lynn Rickey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760403141 PECOS PAC ID: 6002806742 Enrollment ID: I20040514000925 |
| Provider Name | Matthew Walter Marchal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457318503 PECOS PAC ID: 0648254649 Enrollment ID: I20040616001358 |
| Provider Name | Lisa C Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316129893 PECOS PAC ID: 7012093404 Enrollment ID: I20080326000151 |
| Provider Name | Christopher Wade Ogburn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023037165 PECOS PAC ID: 6103015920 Enrollment ID: I20110110000896 |
| Provider Name | Lesli Antoinette Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073749461 PECOS PAC ID: 4880842350 Enrollment ID: I20120907000537 |
K.s. Boodram, Md Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4300 Crossings Blvd Ste 101, Prince George, VA 23875 Phone: 804-526-7900 Fax: 804-526-7195 | |
Careatc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6000 Quality Way, Prince George, VA 23875 Phone: 800-993-8244 | |
Cvhs Hopewell Prince George Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4260 Crossings Blvd, Suite 2, Prince George, VA 23875 Phone: 434-542-5560 Fax: 434-542-5745 |