Provider Demographics
NPI:1619696598
Name:OLYMPUS DIRECT PRIMARY CARE. P.C.
Entity Type:Organization
Organization Name:OLYMPUS DIRECT PRIMARY CARE. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-788-4788
Mailing Address - Street 1:1311 DECATUR HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1737
Mailing Address - Country:US
Mailing Address - Phone:205-927-5185
Mailing Address - Fax:
Practice Address - Street 1:1311 DECATUR HWY STE C
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-1737
Practice Address - Country:US
Practice Address - Phone:205-927-5185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty