Provider Demographics
NPI:1770017030
Name:PRIMARY FAMILY CARE LLC
Entity Type:Organization
Organization Name:PRIMARY FAMILY CARE LLC
Other - Org Name:FRONT ROYAL WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-322-1372
Mailing Address - Street 1:12805 CARA DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2732
Mailing Address - Country:US
Mailing Address - Phone:571-322-1372
Mailing Address - Fax:540-727-8880
Practice Address - Street 1:327 N ROYAL AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2617
Practice Address - Country:US
Practice Address - Phone:571-322-1372
Practice Address - Fax:540-727-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty