Provider Demographics
NPI:1003246877
Name:ANELIME PROFESSIONAL MEDICAL MANAGEMENT LLC.
Entity Type:Organization
Organization Name:ANELIME PROFESSIONAL MEDICAL MANAGEMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKELT
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:480-861-1002
Mailing Address - Street 1:9341 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2632
Mailing Address - Country:US
Mailing Address - Phone:480-861-1002
Mailing Address - Fax:240-252-5668
Practice Address - Street 1:660 S PINAL PKWY APT 106
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9726
Practice Address - Country:US
Practice Address - Phone:520-868-0250
Practice Address - Fax:240-252-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00000282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital