Provider Demographics
NPI:1710306436
Name:PRIME HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:PRIME HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABEER
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:ALIDLEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-740-0977
Mailing Address - Street 1:1004 E MAIN STE D
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3199
Mailing Address - Country:US
Mailing Address - Phone:253-268-0720
Mailing Address - Fax:253-466-7072
Practice Address - Street 1:1004 E MAIN STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3199
Practice Address - Country:US
Practice Address - Phone:253-268-0720
Practice Address - Fax:253-466-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60306063207V00000X
WA000359822080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HD971ZMedicare PIN