| Prime Healthcare,llc | |
|
3233 Superior Ln B21 Bowie MD 20715-1920 | |
| (301) 805-2500 | |
| (301) 805-0114 |
| Full Name | Prime Healthcare,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3233 Superior Ln, Bowie, Maryland |
| Authorized Official Name and Position | Bai Kanu (CEO) |
| Authorized Official Contact | 3018052500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Healthcare,llc 3233 Superior Ln B21 Bowie MD 20715-1920 Ph: (301) 805-2500 | Prime Healthcare,llc 3233 Superior Ln B21 Bowie MD 20715-1920 Ph: (301) 805-2500 |
| NPI Number | 1578743704 |
|---|---|
| Provider Enumeration Date | 11/05/2007 |
| Last Update Date | 12/10/2007 |
| Medicare PECOS PAC ID | 4789585811 |
|---|---|
| Medicare Enrollment ID | O20040120000746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578743704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0058580 (Maryland) | Primary |
| Provider Name | Bai Kanu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033163571 PECOS PAC ID: 6204737331 Enrollment ID: I20040120000779 |
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