# BOMRAY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PrimeCare Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013974864
- **Authorized official:** MRS. JERRI OLSZEWSKI (BILLING REPRESENTATIVE)
- **Authorized official phone:** (704) 335-0806

## Contact information

- **Practice address:** 3627 BEATTIES FORD RD, CHARLOTTE, NC 28216-3249
- **Practice address phone:** (704) 335-0806
- **Practice address fax:** (704) 334-2073
- **Mailing address:** 3627 BEATTIES FORD RD, CHARLOTTE, NC 28216-3249
- **Mailing address phone:** (704) 335-0806
- **Mailing address fax:** (704) 334-2073

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | Yes |
| 261QS1000X | Student Health Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/26/2006
- **Last updated:** 07/20/2010