Provider Demographics
NPI:1629511886
Name:PRIME PULMONARY & SLEEP MEDICINE CENTER, INC
Entity type:Organization
Organization Name:PRIME PULMONARY & SLEEP MEDICINE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGHASIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-853-6738
Mailing Address - Street 1:8333 BRIMHALL RD BLDG 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2243
Mailing Address - Country:US
Mailing Address - Phone:661-695-6777
Mailing Address - Fax:661-695-6767
Practice Address - Street 1:8333 BRIMHALL RD BLDG 1000
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2243
Practice Address - Country:US
Practice Address - Phone:661-695-6777
Practice Address - Fax:661-695-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X, 207RP1001X, 207RS0012X, 261QS1200X
CAA136724261QS1200X
CAA137848261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic