Provider Demographics
NPI:1013690965
Name:FREE STATE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:FREE STATE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-788-2427
Mailing Address - Street 1:365 W PATRICK ST FL 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5093
Mailing Address - Country:US
Mailing Address - Phone:240-647-9049
Mailing Address - Fax:
Practice Address - Street 1:741 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1308
Practice Address - Country:US
Practice Address - Phone:240-647-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty