| Prime Medical Health And Wellness Llc | |
|
24301 Walden Center Dr Ste 300 Bonita Springs FL 34134-4965 | |
| (239) 345-8001 | |
| (239) 345-8003 |
| Full Name | Prime Medical Health And Wellness Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 24301 Walden Center Dr Ste 300, Bonita Springs, Florida |
| Authorized Official Name and Position | Jimmy Liu (OWNER) |
| Authorized Official Contact | 7247599819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Medical Health And Wellness Llc 24301 Walden Center Dr Ste 300 Bonita Springs FL 34134-4965 Ph: (239) 345-8001 | Prime Medical Health And Wellness Llc 24301 Walden Center Dr Ste 300 Bonita Springs FL 34134-4965 Ph: (239) 345-8001 |
| NPI Number | 1790331759 |
|---|---|
| Provider Enumeration Date | 08/15/2019 |
| Last Update Date | 12/18/2019 |
| Medicare PECOS PAC ID | 1052746054 |
|---|---|
| Medicare Enrollment ID | O20200122000831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790331759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Debra M Dooley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437389848 PECOS PAC ID: 0840482741 Enrollment ID: I20101011000806 |
| Provider Name | Jimmy C Liu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699092627 PECOS PAC ID: 5799925350 Enrollment ID: I20130703000188 |
| Provider Name | Jaclyn Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033760731 PECOS PAC ID: 5597199893 Enrollment ID: I20191219000918 |
| Provider Name | Jenna Marie Heller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457935231 PECOS PAC ID: 9335541671 Enrollment ID: I20210709000715 |
| Provider Name | Adrian Martinez Rubio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366154270 PECOS PAC ID: 6305218009 Enrollment ID: I20230307001975 |
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