Provider Demographics
NPI:1053535369
Name:PRIMARY CARE SOLUTIONS INC
Entity type:Organization
Organization Name:PRIMARY CARE SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA QI DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARISIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-537-1022
Mailing Address - Street 1:5601 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8841
Mailing Address - Country:US
Mailing Address - Phone:704-537-1022
Mailing Address - Fax:704-569-0822
Practice Address - Street 1:5601 EXECUTIVE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8841
Practice Address - Country:US
Practice Address - Phone:704-537-1022
Practice Address - Fax:704-569-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X, 1041C0700X, 251S00000X, 343900000X, 363LP0808X
NC8301186251B00000X
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301186BMedicaid
NC8301186GMedicaid