Healthcare Provider Details

I. General information

NPI: 1114385655
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES - LEHIGH PHYSICIAN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LEE BLVD STE 1100
LEHIGH ACRES FL
33936-4887
US

IV. Provider business mailing address

1530 LEE BLVD STE 1100
LEHIGH ACRES FL
33936-4887
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-0241
  • Fax: 239-368-1224
Mailing address:
  • Phone: 239-368-0241
  • Fax: 239-368-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: CHIEF COMPLIANCE COUNSEL
Credential:
Phone: 909-235-4307