Provider Demographics
NPI:1316509656
Name:PMR HEALTHCARE
Entity type:Organization
Organization Name:PMR HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DONADIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-845-5974
Mailing Address - Street 1:7399 N SHADELAND AVE # 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2052
Mailing Address - Country:US
Mailing Address - Phone:516-882-1232
Mailing Address - Fax:
Practice Address - Street 1:2033 E SUMMERSWEET DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6695
Practice Address - Country:US
Practice Address - Phone:516-882-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER MEDICAL RESOUCES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty