Provider Demographics
NPI:1609310358
Name:PRIORITY PRIMARY CARE LLC
Entity type:Organization
Organization Name:PRIORITY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMARASOORIYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARAVELU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-632-4514
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-3546
Mailing Address - Country:US
Mailing Address - Phone:270-632-4514
Mailing Address - Fax:270-632-4518
Practice Address - Street 1:60 SHELTON LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-7203
Practice Address - Country:US
Practice Address - Phone:270-632-4514
Practice Address - Fax:270-632-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty