Provider Demographics
NPI:1194493536
Name:S & J DIRECT PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:S & J DIRECT PRIMARY CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-966-8550
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0836
Mailing Address - Country:US
Mailing Address - Phone:817-966-8550
Mailing Address - Fax:817-612-3261
Practice Address - Street 1:5120 CONCHOS TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3024
Practice Address - Country:US
Practice Address - Phone:817-966-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care