Healthcare Provider Details

I. General information

NPI: 1356984652
Provider Name (Legal Business Name): PRIME HEALING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W SAMPLE RD
CORAL SPRINGS FL
33065-3907
US

IV. Provider business mailing address

10101 W SAMPLE RD
CORAL SPRINGS FL
33065-3907
US

V. Phone/Fax

Practice location:
  • Phone: 954-864-3996
  • Fax: 347-227-1368
Mailing address:
  • Phone: 954-864-3996
  • Fax: 347-227-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY OUSTABASSIDIS
Title or Position: CEO
Credential:
Phone: 954-864-3996