Provider Demographics
NPI:1538057567
Name:PRIMECARE DIRECT LLC
Entity type:Organization
Organization Name:PRIMECARE DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-617-6708
Mailing Address - Street 1:955 PIERREMONT RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2096
Mailing Address - Country:US
Mailing Address - Phone:318-562-3868
Mailing Address - Fax:318-409-1565
Practice Address - Street 1:955 PIERREMONT RD STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2096
Practice Address - Country:US
Practice Address - Phone:318-562-3868
Practice Address - Fax:318-409-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty