Provider Demographics
NPI:1710870696
Name:PRIME HEALTHCARE IOD
Entity type:Organization
Organization Name:PRIME HEALTHCARE IOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CODING AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-263-0256
Mailing Address - Street 1:6 NORTHWESTERN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3416
Mailing Address - Country:US
Mailing Address - Phone:860-580-5656
Mailing Address - Fax:860-580-5799
Practice Address - Street 1:6 NORTHWESTERN DR STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3416
Practice Address - Country:US
Practice Address - Phone:860-580-5656
Practice Address - Fax:860-580-5799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site