=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871457135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE PARTNER AND TELEHEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2025
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6402 MILLERS RUN BACK RUN RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-370-8884
-----------------------------------------------------
Fax | 740-212-8511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6402 MILLERS RUN BACK RUN RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-370-8884
-----------------------------------------------------
Fax | 740-212-8511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP-BC
-----------------------------------------------------
Name | AMANDA BENTLEY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 740-370-8884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------