Provider Demographics
NPI:1356984652
Name:PRIME HEALING CORP
Entity type:Organization
Organization Name:PRIME HEALING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OUSTABASSIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-864-3996
Mailing Address - Street 1:10101 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3907
Mailing Address - Country:US
Mailing Address - Phone:954-864-3996
Mailing Address - Fax:347-227-1368
Practice Address - Street 1:10101 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3907
Practice Address - Country:US
Practice Address - Phone:954-864-3996
Practice Address - Fax:347-227-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty