Provider Demographics
NPI:1629678347
Name:PRIME TELECARE LLC
Entity Type:Organization
Organization Name:PRIME TELECARE LLC
Other - Org Name:PRIME FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LITTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VADAKKAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:512-740-8993
Mailing Address - Street 1:1000 GATTIS SCHOOL RD STE 440
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3313
Mailing Address - Country:US
Mailing Address - Phone:512-740-8993
Mailing Address - Fax:
Practice Address - Street 1:1000 GATTIS SCHOOL RD STE 440
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3313
Practice Address - Country:US
Practice Address - Phone:512-740-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty