Healthcare Provider Details

I. General information

NPI: 1043879471
Provider Name (Legal Business Name): P.R.I.M.E. HEALTH CENTERS - CHESTERFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 CHESTERFIELD INDUSTRIAL BLVD
CHESTERFIELD MO
63005-1201
US

IV. Provider business mailing address

253 CHESTERFIELD INDUSTRIAL BLVD
CHESTERFIELD MO
63005-1201
US

V. Phone/Fax

Practice location:
  • Phone: 636-735-3577
  • Fax:
Mailing address:
  • Phone: 636-735-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE L ADEAMS
Title or Position: PRACTICE ADMINISTRATOR
Credential: PHARMD
Phone: 636-577-7812