Provider Demographics
NPI:1669978300
Name:PRIME CARE PHYSICIANS LLC
Entity type:Organization
Organization Name:PRIME CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREJE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-216-9984
Mailing Address - Street 1:4666 KELL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-4918
Mailing Address - Country:US
Mailing Address - Phone:571-216-9984
Mailing Address - Fax:
Practice Address - Street 1:6299 LEESBURG PIKE STE C
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2101
Practice Address - Country:US
Practice Address - Phone:571-216-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care