Provider Demographics
NPI:1346203171
Name:PRIME HEALTHCARE SERVICES LOWER BUCKS LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES LOWER BUCKS LLC
Other - Org Name:LBH PHYSICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVITALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4309
Mailing Address - Street 1:501 BATH RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3101
Mailing Address - Country:US
Mailing Address - Phone:215-785-9200
Mailing Address - Fax:215-785-9039
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-785-9200
Practice Address - Fax:215-785-9039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES LOWER BUCKS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100745380 002Medicaid
PA000348728OtherHIGHMARK BLUE SHIELD
PA30012055OtherKEYSTONE MERCY
PA0776018000OtherIBC
PA100745380 002Medicaid