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Organization
PRIMECARE OF SOUTHEASTERN OHIO, INC.
Active
Organization
PRIMECARE OF SOUTHEASTERN OHIO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE LUCEY (COO)
(740) 454-4651
Entity
Organization
Contact information
Practice address
751 FOREST AVE STE 402, ZANESVILLE, OH 43701-2878
(740) 454-4651
(740) 454-4653
Mailing address
860 BETHESDA DR, ZANESVILLE, OH 43701-1800
(740) 454-4651
(740) 454-4653
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0989499
—
OH
01
—
CA1586
MEDICARE RAILROAD
—
Enumeration date
12/14/2005
Last updated
03/25/2022
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