| Prime Wound & Foot Care Clinic Inc | |
|
4050 Airport Center Dr Ste B2 Palm Springs CA 92264-1216 | |
| (760) 318-0220 | |
| (760) 318-2288 |
| Full Name | Prime Wound & Foot Care Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4050 Airport Center Dr Ste B2, Palm Springs, California |
| Authorized Official Name and Position | Russell Simon (OWNER) |
| Authorized Official Contact | 4423530488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Wound & Foot Care Clinic Inc 4050 Airport Center Dr Ste B2 Palm Springs CA 92264-1216 Ph: (760) 318-0220 | Prime Wound & Foot Care Clinic Inc 4050 Airport Center Dr Ste B2 Palm Springs CA 92264-1216 Ph: (760) 318-0220 |
| NPI Number | 1396422671 |
|---|---|
| Provider Enumeration Date | 06/29/2023 |
| Last Update Date | 12/20/2023 |
| Medicare PECOS PAC ID | 5294184206 |
|---|---|
| Medicare Enrollment ID | O20231214003844 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396422671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Annalissa L Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740626100 PECOS PAC ID: 5890936363 Enrollment ID: I20130725000385 |
| Provider Name | Lee Bella A Mandap |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629477344 PECOS PAC ID: 7810210457 Enrollment ID: I20150106001556 |
| Provider Name | Russell L Simon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659624948 PECOS PAC ID: 8224390380 Enrollment ID: I20180329002126 |
| Provider Name | Karen Asuncion Roland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730701863 PECOS PAC ID: 2466860390 Enrollment ID: I20240404001541 |
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