Provider Demographics
NPI:1326886359
Name:PRIME HEALTHCARE LTC PC
Entity type:Organization
Organization Name:PRIME HEALTHCARE LTC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULEKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-263-0263
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0263
Mailing Address - Fax:860-263-0267
Practice Address - Street 1:30 JORDAN LN
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1278
Practice Address - Country:US
Practice Address - Phone:860-263-0263
Practice Address - Fax:860-263-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty