Provider Demographics
NPI:1801294764
Name:PRIME HEALTHCARE SERVICES GADSDEN LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES GADSDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:1423 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5397
Mailing Address - Country:US
Mailing Address - Phone:256-549-0014
Mailing Address - Fax:
Practice Address - Street 1:1423 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5397
Practice Address - Country:US
Practice Address - Phone:256-549-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERIVCES GASDEN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-09
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G470001Medicare UPIN
ALHOS0046HMedicaid
1730134123OtherTRICARE
AL010046Medicare Oscar/Certification