Provider Demographics
NPI:1962665828
Name:PRIME CARE MEDICAL SERVICE
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:979-826-3198
Mailing Address - Street 1:900 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-5163
Mailing Address - Country:US
Mailing Address - Phone:979-826-3198
Mailing Address - Fax:979-826-3158
Practice Address - Street 1:900 12TH ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-5163
Practice Address - Country:US
Practice Address - Phone:979-826-3198
Practice Address - Fax:979-826-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management