Healthcare Provider Details

I. General information

NPI: 1609794734
Provider Name (Legal Business Name): PRIMARY SQUARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13553 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4261
US

IV. Provider business mailing address

15801 SWINDON WAY
MIDLOTHIAN VA
23112-5531
US

V. Phone/Fax

Practice location:
  • Phone: 804-614-8619
  • Fax: 844-777-1754
Mailing address:
  • Phone: 804-614-8619
  • Fax: 844-777-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE BRUCE SOWERS III
Title or Position: PRESIDENT & CEO
Credential:
Phone: 804-614-8619