Healthcare Provider Details

I. General information

NPI: 1356731467
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES-GADSDEN PHYSICIAN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BAY ST STE 401
GADSDEN AL
35901-5203
US

IV. Provider business mailing address

303 BAY ST STE 401
GADSDEN AL
35901-5203
US

V. Phone/Fax

Practice location:
  • Phone: 256-467-4731
  • Fax: 256-467-4734
Mailing address:
  • Phone: 256-467-4731
  • Fax: 256-467-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706