| Warren Primary Care Center, Llc | |
|
47 Route 46 Ste 1 Hackettstown NJ 07840-2642 | |
| (908) 852-8750 | |
| (908) 852-8820 |
| Full Name | Warren Primary Care Center, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 47 Route 46 Ste 1, Hackettstown, New Jersey |
| Authorized Official Name and Position | Devi P Gollapudi (PRESIDENT) |
| Authorized Official Contact | 9088528750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Warren Primary Care Center, Llc 47 Route 46 Ste 1 Hackettstown NJ 07840-2642 Ph: (908) 852-8750 | Warren Primary Care Center, Llc 47 Route 46 Ste 1 Hackettstown NJ 07840-2642 Ph: (908) 852-8750 |
| NPI Number | 1992264683 |
|---|---|
| Provider Enumeration Date | 03/13/2019 |
| Last Update Date | 03/14/2019 |
| Medicare PECOS PAC ID | 7911247663 |
|---|---|
| Medicare Enrollment ID | O20190318000425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992264683 | NPI | - | NPPES |
| 7914300 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Devi P Gollapudi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841248036 PECOS PAC ID: 7012951304 Enrollment ID: I20050617000052 |
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