Provider Demographics
NPI:1528667672
Name:PRIME MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:PRIME MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:KOHLER
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-8422
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 690
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6328
Mailing Address - Country:US
Mailing Address - Phone:501-227-8422
Mailing Address - Fax:501-537-2399
Practice Address - Street 1:315 SECTION LINE RD STE A&B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6480
Practice Address - Country:US
Practice Address - Phone:501-776-3800
Practice Address - Fax:501-776-2209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty