Provider Demographics
NPI:1881319127
Name:PRIME SURGERY CENTER
Entity type:Organization
Organization Name:PRIME SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-408-6154
Mailing Address - Street 1:4715 STATESMEN DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1997
Mailing Address - Country:US
Mailing Address - Phone:317-932-3411
Mailing Address - Fax:
Practice Address - Street 1:4715 STATESMEN DR STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1997
Practice Address - Country:US
Practice Address - Phone:317-932-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical