Provider Demographics
NPI:1518121854
Name:PRIME TIME MEDICAL, INC.
Entity Type:Organization
Organization Name:PRIME TIME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIKLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-548-8386
Mailing Address - Street 1:7201 BRYAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1505
Mailing Address - Country:US
Mailing Address - Phone:727-548-8386
Mailing Address - Fax:727-548-7985
Practice Address - Street 1:7201 BRYAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1505
Practice Address - Country:US
Practice Address - Phone:727-548-8386
Practice Address - Fax:727-548-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002348200Medicaid
FL002348200Medicaid