Provider Demographics
NPI:1366498404
Name:PRIME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PRIME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-380-8812
Mailing Address - Street 1:5600 SW 135TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5182
Mailing Address - Country:US
Mailing Address - Phone:305-380-8812
Mailing Address - Fax:305-380-8879
Practice Address - Street 1:5600 SW 135TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5182
Practice Address - Country:US
Practice Address - Phone:305-380-8812
Practice Address - Fax:305-380-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4331261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0917Medicare ID - Type UnspecifiedPROVIDER NUMBER