Healthcare Provider Details

I. General information

NPI: 1306396148
Provider Name (Legal Business Name): PRIME MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W JEFFERSON ST SUITE 401
BLOOMINGTON IL
61701-3946
US

IV. Provider business mailing address

115 W JEFFERSON ST SUITE 401
BLOOMINGTON IL
61701-3946
US

V. Phone/Fax

Practice location:
  • Phone: 309-828-4361
  • Fax:
Mailing address:
  • Phone: 309-828-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID UNDERWOOD
Title or Position: EXEC VP & CFO
Credential: CPA
Phone: 309-823-7135