Provider Demographics
NPI:1154844348
Name:PRYME FOOT & ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:PRYME FOOT & ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:682-223-2400
Mailing Address - Street 1:1759 BROAD PARK CIR S #205
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7834
Mailing Address - Country:US
Mailing Address - Phone:682-223-2400
Mailing Address - Fax:682-334-7061
Practice Address - Street 1:1759 BROAD PARK CIR S #205
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7834
Practice Address - Country:US
Practice Address - Phone:682-223-2400
Practice Address - Fax:682-334-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
811363748OtherTAX ID