Provider Demographics
NPI:1124733167
Name:PRIMETOWN OHIO LLC
Entity type:Organization
Organization Name:PRIMETOWN OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:740-704-1225
Mailing Address - Street 1:905 N 21ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7251
Mailing Address - Country:US
Mailing Address - Phone:740-281-3663
Mailing Address - Fax:740-281-3818
Practice Address - Street 1:905 N 21ST ST STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7251
Practice Address - Country:US
Practice Address - Phone:740-281-3663
Practice Address - Fax:740-281-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center