Provider Demographics
NPI:1033454723
Name:PRIME PHYSICIANS LLC
Entity Type:Organization
Organization Name:PRIME PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KALYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKKINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-426-3918
Mailing Address - Street 1:5808 CALLAWAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8437
Mailing Address - Country:US
Mailing Address - Phone:479-696-8880
Mailing Address - Fax:
Practice Address - Street 1:5808 CALLAWAY LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-8437
Practice Address - Country:US
Practice Address - Phone:479-696-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty