Provider Demographics
NPI:1215662564
Name:PRIME MEDICAL CARE PLLC
Entity type:Organization
Organization Name:PRIME MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRANAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-870-0699
Mailing Address - Street 1:700 N ESTRELLA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9330
Mailing Address - Country:US
Mailing Address - Phone:480-870-0699
Mailing Address - Fax:480-870-0695
Practice Address - Street 1:700 N ESTRELLA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9330
Practice Address - Country:US
Practice Address - Phone:480-870-0699
Practice Address - Fax:480-870-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35727OtherLICENSE