# PRIMARY ACCESS MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801032164
- **Authorized official:** BRENT PRATLEY MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (562) 728-9600

## Contact information

- **Practice address:** 273 E SOUTH ST, LONG BEACH, CA 90805-4631
- **Practice address phone:** (562) 728-9600
- **Practice address fax:** (562) 422-9011
- **Mailing address:** PO BOX 607, SAN DIMAS, CA 91773-0607
- **Mailing address phone:** (909) 971-9334
- **Mailing address fax:** (909) 971-9654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | A54374 | CA | — |
| 208D00000X | General Practice Physician | A36774 | CA | Yes |

## Other

- **Enumeration date:** 12/16/2008
- **Last updated:** 12/16/2008