National Provider Identifier Database

PRIMARY CARE SPECIALISTS PA
Primary Care


Contact Information

PRIMARY CARE SPECIALISTS, PA
110 VISTA DRIVE
POCATELLO, ID83201
Phone: 208-234-2300
Fax: 208-234-0026
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for PRIMARY CARE SPECIALISTS, PA

NPI Number 1508875881
Legal business name
LBN
PRIMARY CARE SPECIALISTS, PA
Authorized official MARK MANSFIELD - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 08/05/2006
Last updated 09/18/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • ID Medicaid: 805105400

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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