Healthcare Provider Details

I. General information

NPI: 1073503637
Provider Name (Legal Business Name): PRIME HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RITTER DRIVE
BEAVER WV
25813
US

IV. Provider business mailing address

PO BOX 550
BEAVER WV
25813-0550
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-1300
  • Fax: 304-255-5391
Mailing address:
  • Phone: 304-255-1300
  • Fax: 304-255-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BELLA N ZINZUWADIA
Title or Position: PRESIDENT
Credential: MD
Phone: 304-255-1300