Prima Medical Care Llc | |
99 Riviera Dr Lake Havasu City AZ 86403-5713 | |
(928) 302-3798 | |
Not Available |
Full Name | Prima Medical Care Llc |
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Speciality | General Practice |
Location | 99 Riviera Dr, Lake Havasu City, Arizona |
Authorized Official Name and Position | Katie Jean Colonna (OWNER) |
Authorized Official Contact | 9283023798 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Prima Medical Care Llc 99 Riviera Dr Lake Havasu City AZ 86403-5713 Ph: (928) 302-3798 | Prima Medical Care Llc 99 Riviera Dr Lake Havasu City AZ 86403-5713 Ph: (928) 302-3798 |
NPI Number | 1467225789 |
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Provider Enumeration Date | 10/30/2023 |
Last Update Date | 10/03/2024 |
Medicare PECOS PAC ID | 4789037078 |
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Medicare Enrollment ID | O20240202002022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467225789 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Provider Name | Michael Colonna |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1508007477 PECOS PAC ID: 0446564645 Enrollment ID: I20151117001738 |
Provider Name | Katie Jean Colonna |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558083923 PECOS PAC ID: 2567835812 Enrollment ID: I20230307001582 |
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