1871853879 NPI number — PRIME SERVICES LLC

Table of content: (NPI 1871853879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871853879 NPI number — PRIME SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME SERVICES LLC
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:
Provider Other Organization Name Type Code:
6
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:
1871853879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45593 SHEPARD DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20164-4409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-621-0668
Provider Business Mailing Address Fax Number:
703-790-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45593 SHEPARD DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20164-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-621-0668
Provider Business Practice Location Address Fax Number:
703-790-5388
Provider Enumeration Date:
05/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OLOYEDE
Authorized Official First Name:
OLUFUNKE
Authorized Official Middle Name:
BECKY
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
202-492-2704

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0156717008 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0157294650 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com