Provider Demographics
NPI:1619123692
Name:PRIMARY AND URGENT CARE,LLC
Entity Type:Organization
Organization Name:PRIMARY AND URGENT CARE,LLC
Other - Org Name:PRIMARY AND URGENT CARE,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-785-9900
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3910
Mailing Address - Country:US
Mailing Address - Phone:540-785-9900
Mailing Address - Fax:
Practice Address - Street 1:4510 PLANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0138
Practice Address - Country:US
Practice Address - Phone:540-785-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY AND URGENT CARE,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-11
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0101243323207QA0505X
VA0101057815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08404Medicare PIN