Provider Demographics
NPI:1689046880
Name:PRIME NEURODIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PRIME NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-428-7041
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71234-0249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 RUGGS BLUFF RD
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71234-3717
Practice Address - Country:US
Practice Address - Phone:318-237-4073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZB0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiostatisticianGroup - Single Specialty