Healthcare Provider Details

I. General information

NPI: 1740144617
Provider Name (Legal Business Name): PRIMARY EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CLEVELAND AVE STE A
MARTINSVILLE VA
24112-3714
US

IV. Provider business mailing address

209 CLEVELAND AVE STE A
MARTINSVILLE VA
24112-3714
US

V. Phone/Fax

Practice location:
  • Phone: 276-252-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CODY V WILLIAMS JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 276-252-4200