Provider Demographics
NPI:1003466319
Name:PRIMARY CARE 360
Entity Type:Organization
Organization Name:PRIMARY CARE 360
Other - Org Name:URGENT CARE 360
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:591-833-4001
Mailing Address - Street 1:100 SHADOW OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6046
Mailing Address - Country:US
Mailing Address - Phone:591-833-4001
Mailing Address - Fax:888-213-5007
Practice Address - Street 1:100 SHADOW OAKS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6046
Practice Address - Country:US
Practice Address - Phone:591-833-4001
Practice Address - Fax:888-213-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care