| Prima Medical Care Llc | |
|
99 Riviera Dr Lake Havasu City AZ 86403-5713 | |
| (503) 851-0575 | |
| Not Available |
| Full Name | Prima Medical Care Llc |
|---|---|
| Speciality | General Practice |
| Location | 99 Riviera Dr, Lake Havasu City, Arizona |
| Authorized Official Name and Position | Katie Jean Colonna (OWNER) |
| Authorized Official Contact | 5038510575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prima Medical Care Llc 99 Riviera Dr Lake Havasu City AZ 86403-5713 Ph: (503) 851-0575 | Prima Medical Care Llc 99 Riviera Dr Lake Havasu City AZ 86403-5713 Ph: (503) 851-0575 |
| NPI Number | 1467225789 |
|---|---|
| Provider Enumeration Date | 10/30/2023 |
| Last Update Date | 07/05/2024 |
| Medicare PECOS PAC ID | 4789037078 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508007477 PECOS PAC ID: 0446564645 Enrollment ID: I20151117001738 |
| Provider Name | Katie Jean Colonna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558083923 PECOS PAC ID: 2567835812 Enrollment ID: I20230307001582 |
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