Provider Demographics
NPI:1164887972
Name:PRIMEBODY
Entity Type:Organization
Organization Name:PRIMEBODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIMCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-732-4412
Mailing Address - Street 1:14500 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3658
Mailing Address - Country:US
Mailing Address - Phone:602-732-4418
Mailing Address - Fax:602-569-9027
Practice Address - Street 1:11611 E SAHUARO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3163
Practice Address - Country:US
Practice Address - Phone:602-732-4418
Practice Address - Fax:602-569-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization