Provider Demographics
NPI:1306569868
Name:PRIME CARE 12 PRIORITY HEALTH INC.
Entity type:Organization
Organization Name:PRIME CARE 12 PRIORITY HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:304-425-0085
Mailing Address - Street 1:702 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2406
Mailing Address - Country:US
Mailing Address - Phone:304-425-0085
Mailing Address - Fax:304-487-6993
Practice Address - Street 1:702 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2406
Practice Address - Country:US
Practice Address - Phone:304-425-0085
Practice Address - Fax:304-487-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care