Healthcare Provider Details

I. General information

NPI: 1013538057
Provider Name (Legal Business Name): PRIMECARE CONSULTING AND MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ANDERSON HWY STE A
POWHATAN VA
23139-7400
US

IV. Provider business mailing address

2615 ANDERSON HWY STE A
POWHATAN VA
23139-7400
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TOBY BAYLESS
Title or Position: CEO
Credential:
Phone: 804-794-1555