| Prime Healing Corp | |
|
10101 W Sample Rd Coral Springs FL 33065-3907 | |
| (954) 864-3996 | |
| (347) 227-1368 |
| Full Name | Prime Healing Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 10101 W Sample Rd, Coral Springs, Florida |
| Authorized Official Name and Position | Tony Oustabassidis (CEO) |
| Authorized Official Contact | 9548643996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Healing Corp 10101 W Sample Rd Coral Springs FL 33065-3907 Ph: (954) 864-3996 | Prime Healing Corp 10101 W Sample Rd Coral Springs FL 33065-3907 Ph: (954) 864-3996 |
| NPI Number | 1356984652 |
|---|---|
| Provider Enumeration Date | 10/20/2019 |
| Last Update Date | 10/20/2019 |
| Medicare PECOS PAC ID | 8123457371 |
|---|---|
| Medicare Enrollment ID | O20200409000744 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356984652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Anil Dutt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134165699 PECOS PAC ID: 8820085582 Enrollment ID: I20180404002900 |
| Provider Name | Christine Ann Lada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790459485 PECOS PAC ID: 5496184640 Enrollment ID: I20220409000118 |
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