Provider Demographics
NPI:1164289054
Name:COMMAND PRIME, LLC
Entity Type:Organization
Organization Name:COMMAND PRIME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:VAN KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-693-8618
Mailing Address - Street 1:3238 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7303
Mailing Address - Country:US
Mailing Address - Phone:417-351-2900
Mailing Address - Fax:
Practice Address - Street 1:2740 N MAYFAIR AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-5084
Practice Address - Country:US
Practice Address - Phone:417-521-3925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty