Provider Demographics
NPI:1215787700
Name:PRIME TIME PHYSICIANS, LLC
Entity type:Organization
Organization Name:PRIME TIME PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYAAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIBULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-268-5725
Mailing Address - Street 1:1605 KEEGAN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6252
Mailing Address - Country:US
Mailing Address - Phone:573-268-5725
Mailing Address - Fax:
Practice Address - Street 1:217 W REED ST
Practice Address - Street 2:STE A5
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:573-268-5725
Practice Address - Fax:877-673-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty