1649525841 NPI number — PRIME MEDICAL RESOURCES, INC.

Table of content: (NPI 1649525841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649525841 NPI number — PRIME MEDICAL RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME MEDICAL RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIME ORTHOPEDICS, PRIME ELECTRO CARE, PRIME SURGICAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649525841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 N SAN FERNANDO BLVD
Provider Second Line Business Mailing Address:
#315
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91504-4236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-555-1051
Provider Business Mailing Address Fax Number:
800-555-9161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 COMMERCE AVE
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-555-1051
Provider Business Practice Location Address Fax Number:
800-555-9161
Provider Enumeration Date:
07/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROZO
Authorized Official First Name:
JOSSELYN
Authorized Official Middle Name:
ANDREA
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
818-568-6553

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  55721 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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