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Organization
PRIMARY CARE CENTER INC
Active
Organization
PRIMARY CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES DAVID DIETHELM M.D. (OWNER)
(419) 473-2273
Entity
Organization
Contact information
Practice address
7640 SYLVANIA AVE, SUITE E, SYLVANIA, OH 43560-9729
(419) 473-2273
Mailing address
7640 SYLVANIA AVE, SUITE E, SYLVANIA, OH 43560-9729
(419) 473-2273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35041896
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2218451
—
OH
01
—
CH6078
RAILROAD MEDICARE
OH
Enumeration date
10/12/2006
Last updated
11/19/2007
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