Provider Demographics
NPI:1558810077
Name:PRIME HOME VISIT & TELEMEDICINE SERVICES PLLC
Entity Type:Organization
Organization Name:PRIME HOME VISIT & TELEMEDICINE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:989-791-2455
Mailing Address - Street 1:3175 CHRISTY WAY S STE 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2210
Mailing Address - Country:US
Mailing Address - Phone:989-401-7000
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:3175 CHRISTY WAY S
Practice Address - Street 2:STE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2210
Practice Address - Country:US
Practice Address - Phone:989-401-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty