Organization
PRIMARY MEDICAL SPECIALISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZANN M BONZO MD (PRESIDENT)
(740) 353-4143
Entity
Organization
Contact information
Practice address
1611 27TH ST, FULTON BLDG. SUITE 101, PORTSMOUTH, OH 45662-6931
(740) 353-4143
(740) 353-1714
Mailing address
1611 27TH ST, FULTON BLDG. SUITE 101, PORTSMOUTH, OH 45662-6931
(740) 353-4143
(740) 353-1714
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35043902
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000262223
BLUECROSS/BLUE SHIELD
OH
01
—
110248769
RR MEDICARE
OH
05
—
2228619
—
OH
Enumeration date
10/18/2007
Last updated
07/01/2010
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