Provider Demographics
NPI:1265062434
Name:PRIME CARDIOVASCULAR, LLC
Entity type:Organization
Organization Name:PRIME CARDIOVASCULAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-284-9541
Mailing Address - Street 1:3196 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9303
Mailing Address - Country:US
Mailing Address - Phone:662-284-9541
Mailing Address - Fax:662-284-9543
Practice Address - Street 1:3196 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9303
Practice Address - Country:US
Practice Address - Phone:662-284-9541
Practice Address - Fax:662-284-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty