Provider Demographics
NPI:1003384678
Name:PRIME CLINICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PRIME CLINICAL ASSOCIATES, LLC
Other - Org Name:PRIME CLINICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAUNTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:443-847-6822
Mailing Address - Street 1:9649 BELAIR ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1116
Mailing Address - Country:US
Mailing Address - Phone:410-237-6904
Mailing Address - Fax:410-237-6912
Practice Address - Street 1:9649 BELAIR ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1116
Practice Address - Country:US
Practice Address - Phone:410-237-6904
Practice Address - Fax:410-237-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health