Provider Demographics
NPI:1821734716
Name:PRIME HEALTH ACO, LLC
Entity Type:Organization
Organization Name:PRIME HEALTH ACO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-771-1116
Mailing Address - Street 1:7685 103RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9326
Mailing Address - Country:US
Mailing Address - Phone:904-771-1116
Mailing Address - Fax:904-394-5115
Practice Address - Street 1:7685 103RD ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9326
Practice Address - Country:US
Practice Address - Phone:904-771-1116
Practice Address - Fax:904-394-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7685OtherLOCATION