Healthcare Provider Details

I. General information

NPI: 1790174860
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES MESQUITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N GALLOWAY AVE
MESQUITE TX
75149-2433
US

IV. Provider business mailing address

1011 N GALLOWAY AVE
MESQUITE TX
75149-2433
US

V. Phone/Fax

Practice location:
  • Phone: 214-320-7000
  • Fax:
Mailing address:
  • Phone: 214-320-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: PREM REDDY
Title or Position: CHAIRMAN/PRESIDENT
Credential:
Phone: 909-235-4400