Healthcare Provider Details

I. General information

NPI: 1669387254
Provider Name (Legal Business Name): PRIMARYARC HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 CHANTILLY PKWY CT UNIT L
PIKE ROAD AL
36064-2881
US

IV. Provider business mailing address

11123 CHANTILLY PKWY CT UNIT L
PIKE ROAD AL
36064-2881
US

V. Phone/Fax

Practice location:
  • Phone: 407-962-7067
  • Fax:
Mailing address:
  • Phone: 407-962-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MILAN VYAS
Title or Position: MANAGING MEMBER
Credential:
Phone: 407-962-7067