MEDICARE: PRIME CARES LLC

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	332BD1200X	Dialysis Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1720806938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARES LLC

Provider Business Mailing Address
First Line	:	1021 E LINCOLNWAY # 7335
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 E LINCOLNWAY # 7335
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4851
Country	:	US
Telephone Number	:	469-915-5044
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ABRAHAM BORNSTEIN
Credential	:
Telephone Number	:	469-915-5044

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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Directions to “PRIME CARES LLC ” Practice Location

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