| Priority Primary Care LLC | |
|
60 Shelton Ln Russellville KY 42276-7203 | |
| (270) 632-4514 | |
| (270) 632-4518 |
| Full Name | Priority Primary Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 60 Shelton Ln, Russellville, Kentucky |
| Authorized Official Name and Position | Kumarasooriyar Kumaravelu (OWNER) |
| Authorized Official Contact | 2706324514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Priority Primary Care LLC Po Box 1546 Russellville KY 42276-3546 Ph: (270) 632-4514 | Priority Primary Care LLC 60 Shelton Ln Russellville KY 42276-7203 Ph: (270) 632-4514 |
| NPI Number | 1609310358 |
|---|---|
| Provider Enumeration Date | 12/15/2016 |
| Last Update Date | 03/02/2018 |
| Medicare PECOS PAC ID | 8022392216 |
|---|---|
| Medicare Enrollment ID | O20170308000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609310358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 363L00000X | Nurse Practitioner | (NU) | Secondary |
| 208000000X | Pediatrics | (NU) | Secondary |
| Provider Name | David L Mcclain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790771954 PECOS PAC ID: 5092977660 Enrollment ID: I20120426000345 |
| Provider Name | Carlton a Lee |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396150413 PECOS PAC ID: 8426279795 Enrollment ID: I20141030000934 |
| Provider Name | Lashawnda G Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104471911 PECOS PAC ID: 3577997824 Enrollment ID: I20191219002876 |
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