Provider Demographics
NPI:1306489406
Name:PRIME ENDOCRINOLOGY LLC
Entity type:Organization
Organization Name:PRIME ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-455-7009
Mailing Address - Street 1:11321 INTERSTATE 30 STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7066
Mailing Address - Country:US
Mailing Address - Phone:501-455-7009
Mailing Address - Fax:501-455-7026
Practice Address - Street 1:11321 INTERSTATE 30 STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7066
Practice Address - Country:US
Practice Address - Phone:501-455-7009
Practice Address - Fax:501-455-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty