Provider Demographics
NPI:1457612582
Name:PRIME COMMUNITY CARE, INC.
Entity Type:Organization
Organization Name:PRIME COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-605-8000
Mailing Address - Street 1:3990 CONCOURS
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-7970
Mailing Address - Country:US
Mailing Address - Phone:909-605-8000
Mailing Address - Fax:
Practice Address - Street 1:3990 CONCOURS
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-7970
Practice Address - Country:US
Practice Address - Phone:909-605-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty