Provider Demographics
NPI:1295117554
Name:PRIME PSYCHIATRY PA
Entity type:Organization
Organization Name:PRIME PSYCHIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EFOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIRUEHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-777-4691
Mailing Address - Street 1:11330 LEGACY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1210
Mailing Address - Country:US
Mailing Address - Phone:469-777-4691
Mailing Address - Fax:469-777-4542
Practice Address - Street 1:11330 LEGACY DR STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1210
Practice Address - Country:US
Practice Address - Phone:469-777-4691
Practice Address - Fax:469-777-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 2084A0401X, 363A00000X, 363LP0808X, 2084P0800X
TXQ2227261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty