Provider Demographics
NPI:1467225789
Name:PRIMA MEDICAL CARE LLC
Entity Type:Organization
Organization Name:PRIMA MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COLONNA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:503-851-0575
Mailing Address - Street 1:99 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5713
Mailing Address - Country:US
Mailing Address - Phone:503-851-0575
Mailing Address - Fax:
Practice Address - Street 1:99 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5713
Practice Address - Country:US
Practice Address - Phone:503-851-0575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty