Provider Demographics
NPI:1619453537
Name:PHYSICIAN CARE DIRECT, LLC
Entity Type:Organization
Organization Name:PHYSICIAN CARE DIRECT, LLC
Other - Org Name:EHOP HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:855-723-2300
Mailing Address - Street 1:1457 KELLY RD # 112
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9572
Mailing Address - Country:US
Mailing Address - Phone:855-723-2300
Mailing Address - Fax:
Practice Address - Street 1:223 WONDERLAND TRL
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-6376
Practice Address - Country:US
Practice Address - Phone:855-723-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health