Provider Demographics
NPI:1932629680
Name:PRIME HEALTH MEDICAL OFFICES LLC
Entity Type:Organization
Organization Name:PRIME HEALTH MEDICAL OFFICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN. CNP
Authorized Official - Prefix:
Authorized Official - First Name:MANINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-510-0443
Mailing Address - Street 1:4343 BRIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9227
Mailing Address - Country:US
Mailing Address - Phone:513-510-0443
Mailing Address - Fax:
Practice Address - Street 1:4343 BRIGHTON LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9227
Practice Address - Country:US
Practice Address - Phone:513-510-0443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.019916OtherCERTIFICATE OF AUTHORITY
1659798031OtherINDIVIDUAL NPI