PRIMARY CARE 360 (NPI# 1134734049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134734049 |
| Entity Type | Organization |
| Organization Name | PRIMARY CARE 360 |
| Practice Address |
103 Frankie Ln White Hall AR 71602-2685 |
| Practice Telephone | 8703935050 |
| Mailing Telephone | 8703935050 |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |
| Authorized Official Name | KHALID RAYAZ (OWNER) |
| Authorized Official Telephone | 8703935050 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIMARY CARE 360 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| Urgent Care 360 White Hall | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649885559 | Primary Care 360 | Family Medicine | 20602 Arch Street Pike, Hensley, AR 72065-9442 | 2020-09-09 |
| 1124678586 | Primary Care 360 | Family Medicine | 100 Shadow Oaks Dr, Sherwood, AR 72120-6046 | 2019-09-18 |
| 1003466319 | Primary Care 360 | Clinic/Center | 100 Shadow Oaks Dr, Sherwood, AR 72120-6046 | 2019-09-18 |
| Street Address |
103 FRANKIE LN |
| City | WHITE HALL |
| State | AR |
| Zip Code | 71602-2685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679571863 | Tracy Thomas Phillips | Family Medicine | 103 Frankie Ln, White Hall, AR 71602-2685 | 2005-07-12 |
| 1356849046 | Raluca Tudoreanu | Nurse Practitioner | 103 Frankie Ln, White Hall, AR 71602-2685 | 2018-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265050447 | Bridget Furlong | Occupational Therapist | 2226 Barncy Lane, White Hall, AR 71602 | 2020-07-14 |
| 1609399963 | Interventional Surgery Institute of White Hall LLC | Clinic/Center | 7211 Dollarway Road, White Hall, AR 71602 | 2017-07-19 |
| 1679935761 | Pain Treatment Centers of America, Pllc | Durable Medical Equipment & Medical Supplies | 7211 Dollarway Rd, White Hall, AR 71602 | 2016-03-28 |
| 1326450446 | Rafeek Hegazy | Anesthesiology | 202 Frankie Ln, White Hall, AR 71602 | 2014-05-22 |
| 1275873515 | Craig Paul Anderson | Preventive Medicine | 13-020 Kabrich Circle, Pine Bluff, AR 71602 | 2013-02-24 |
| 1124258553 | Shellia Anne Kornegay | Nurse Practitioner | 1515 West 42nd Street, Pine Bluff, AR 71602 | 2009-07-20 |
| 1275789109 | Sarah Allison Rushing | Speech-Language Pathologist | 1020 West Holland Avenue, White Hall, AR 71602 | 2008-08-12 |
| 1245438852 | White Hall School District | Local Education Agency (LEA) | 1020 West Holland, White Hall, AR 71602 | 2007-07-05 |
| 1972622652 | Dewey Charles Scarbrough | Physician Assistant | 109 Frankie Lane, White Hall, AR 71602 | 2007-03-27 |
| 1427126135 | Donna D Massey | Dentist | 7215 Sheridan Road, White Hall, AR 71602 | 2006-12-01 |
| Find all providers in zip 71602 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821321480 | Mp Sales | Non-Pharmacy Dispensing Site | 303 E Carlinville St, White Hall, IL 62092-1207 | 2009-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114437985 | Physician Comp Rx, LLC | Non-Pharmacy Dispensing Site | 540 E Appleby Rd Ste 104, Fayetteville, AR 72703-4114 | 2017-10-06 |
| 1972061430 | Vafa Ferdowsian Dpm, P.a. | Non-Pharmacy Dispensing Site | 1713 W Main St, Russellville, AR 72801-2721 | 2019-03-04 |
| 1922566470 | Vafa Ferdowsian Dpm, P.a. | Non-Pharmacy Dispensing Site | 610 Highway 5 N, Benton, AR 72019-8559 | 2019-03-04 |
| 1174063846 | Verity Revenue, Inc. | Non-Pharmacy Dispensing Site | 6801 Isaacs Orchard Rd, Suite 210, Springdale, AR 72762-6545 | 2017-03-01 |
| 1922285147 | Vafa Ferdowsian Dpm, P.a. | Non-Pharmacy Dispensing Site | 1120 Hogan Ln Ste B, Conway, AR 72034-8216 | 2008-01-30 |
| City | WHITE HALL |
| Zip Code | 71602 |
Please comment or provide details below to improve the information on PRIMARY CARE 360.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.