MEDICARE: PRIME VISTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679415095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME VISTA

Provider Business Mailing Address
First Line	:	1103 WALLS CHURCH RD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-8640
Country	:	US
Telephone Number	:	909-670-2881
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 WALLS CHURCH RD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-8640
Country	:	US
Telephone Number	:	909-670-2881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH DARLENE LOVELACE
Credential	:
Telephone Number	:	190-967-0288

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/09/2026

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Directions to “PRIME VISTA ” Practice Location

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