Provider Demographics
NPI:1710218540
Name:PRIME HEALTHCENTRAL
Entity Type:Organization
Organization Name:PRIME HEALTHCENTRAL
Other - Org Name:MEDICKASS INTERNATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO,MPH
Authorized Official - Phone:954-889-7134
Mailing Address - Street 1:3540 NW 121ST AVE
Mailing Address - Street 2:BOX 451447
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3302
Mailing Address - Country:US
Mailing Address - Phone:954-889-7134
Mailing Address - Fax:
Practice Address - Street 1:630 DATURA ST
Practice Address - Street 2:APT 12-A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5314
Practice Address - Country:US
Practice Address - Phone:954-889-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory