Provider Demographics
NPI:1710337621
Name:PRIOLA PRIMARY PALLIATIVE AND HOSPICE CARE, PLLC
Entity Type:Organization
Organization Name:PRIOLA PRIMARY PALLIATIVE AND HOSPICE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-778-0626
Mailing Address - Street 1:3105 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7166
Mailing Address - Country:US
Mailing Address - Phone:928-778-0626
Mailing Address - Fax:888-289-2598
Practice Address - Street 1:3105 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7166
Practice Address - Country:US
Practice Address - Phone:928-778-0626
Practice Address - Fax:888-289-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ575416Medicaid
AZ1407161235OtherNPI
Z145588Medicare UPIN