Provider Demographics
NPI:1700281656
Name:TOTAL PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:TOTAL PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PONNURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-339-9355
Mailing Address - Street 1:5701 W 119TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3750
Mailing Address - Country:US
Mailing Address - Phone:913-339-9355
Mailing Address - Fax:
Practice Address - Street 1:5701 W 119TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3750
Practice Address - Country:US
Practice Address - Phone:913-339-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS449157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty