Provider Demographics
NPI:1427617851
Name:P.R.I.M.E. HEALTH CENTERS - FLORISSANT LLC
Entity type:Organization
Organization Name:P.R.I.M.E. HEALTH CENTERS - FLORISSANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-577-7812
Mailing Address - Street 1:18 GRANDVIEW PLAZA SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6105
Mailing Address - Country:US
Mailing Address - Phone:314-627-1411
Mailing Address - Fax:314-627-1406
Practice Address - Street 1:18 GRANDVIEW PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6105
Practice Address - Country:US
Practice Address - Phone:314-627-1411
Practice Address - Fax:314-627-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty