Provider Demographics
NPI:1720468390
Name:PRIMARY VISITING CLINICIANS PLLC
Entity Type:Organization
Organization Name:PRIMARY VISITING CLINICIANS PLLC
Other - Org Name:PVC FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAINABU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:972-979-7408
Mailing Address - Street 1:3334 BROADWAY BLVD STE 422
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1575
Mailing Address - Country:US
Mailing Address - Phone:972-979-7408
Mailing Address - Fax:972-587-6733
Practice Address - Street 1:3334 BROADWAY BLVD STE 422
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1575
Practice Address - Country:US
Practice Address - Phone:972-979-7408
Practice Address - Fax:972-587-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5507207R00000X
TXAP120628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty