Provider Demographics
NPI:1184083610
Name:PRIME MEDICAL GROUP
Entity type:Organization
Organization Name:PRIME MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-788-7505
Mailing Address - Street 1:712 BANCROFT RD # 438
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1531
Mailing Address - Country:US
Mailing Address - Phone:925-788-7505
Mailing Address - Fax:
Practice Address - Street 1:5439 CLAYTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1086
Practice Address - Country:US
Practice Address - Phone:925-672-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-11
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care