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General NPI Number Information
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NPI Number | 1609310358
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Entity Type | Organization
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Legal Business Name | PRIORITY PRIMARY CARE LLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 60 SHELTON LN
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-7203
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Country | US
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Telephone | 270-632-4514
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Fax | 270-632-4518
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Provider Business Mailing Address
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Address Line | PO BOX 1546
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-3546
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Country | US
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Telephone | 270-632-4514
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Fax | 270-632-4518
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Authorized Official
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Title or Position | OWNER
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Name | KUMARASOORIYAR KUMARAVELU
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Credential | MD
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Telephone | 270-632-4514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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