Provider Demographics
NPI:1679832729
Name:PRIME MEDICAL CLINIC, PLC
Entity Type:Organization
Organization Name:PRIME MEDICAL CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-840-3584
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:SUITE B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3925
Mailing Address - Country:US
Mailing Address - Phone:602-840-3584
Mailing Address - Fax:602-957-2184
Practice Address - Street 1:3104 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6889
Practice Address - Country:US
Practice Address - Phone:602-840-3584
Practice Address - Fax:602-957-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729130Medicaid
AZZ153716Medicare PIN