MEDICARE: COMMAND PRIME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164289054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMAND PRIME, LLC

Provider Business Mailing Address
First Line	:	3238 S NATIONAL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-7303
Country	:	US
Telephone Number	:	417-351-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 N MAYFAIR AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-5084
Country	:	US
Telephone Number	:	417-521-3925
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. LUKE AARON VAN KIRK
Credential	:	DO
Telephone Number	:	417-693-8618

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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Directions to “COMMAND PRIME, LLC ” Practice Location

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