Healthcare Provider Details

I. General information

NPI: 1619123692
Provider Name (Legal Business Name): PRIMARY AND URGENT CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 PLANK RD SUITE 200
FREDERICKSBURG VA
22407-0138
US

IV. Provider business mailing address

PO BOX 3910
FREDERICKSBURG VA
22402-3910
US

V. Phone/Fax

Practice location:
  • Phone: 540-785-9900
  • Fax:
Mailing address:
  • Phone: 540-785-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101243323
License Number State

VIII. Authorized Official

Name: NATHER ANSARI
Title or Position: OWNER
Credential: MD
Phone: 540-785-9900