Provider Demographics
NPI:1023091600
Name:PRIMECARE PSC
Entity type:Organization
Organization Name:PRIMECARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-4535
Mailing Address - Street 1:2413 RING RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5924
Mailing Address - Country:US
Mailing Address - Phone:270-765-4535
Mailing Address - Fax:270-763-1901
Practice Address - Street 1:2413 RING RD STE 110
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5924
Practice Address - Country:US
Practice Address - Phone:270-765-4535
Practice Address - Fax:270-763-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0401X, 363AM0700X, 363L00000X
KY26429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507510Medicaid
KY78904083Medicaid
KY65922940Medicaid
KY7100060440Medicaid
KY65922940Medicaid