Primary Care Physicians IV, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIMARY CARE PHYSICIANS IV, P.C.

Practice address

21331 Kelly Rd
Eastpointe, MI 48021-3265

Phone

(586) 498-8922

Fax

(586) 498-8935

NPI assigned

Apr 28, 2010

Last updated

Apr 28, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yvonne Gibson

Title

Director of Operations

Phone

(586) 498-8922

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1912224148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21331 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213265",
            "telephone_number": "586-498-8922",
            "fax_number": "586-498-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21331 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213265",
            "telephone_number": "586-498-8922",
            "fax_number": "586-498-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE PHYSICIANS IV, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "586-498-8922"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.