Healthcare Provider Details

I. General information

NPI: 1104025741
Provider Name (Legal Business Name): PRIME HEALTH ASSOCIATES DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ROBERT C. BYRD DRIVE
CRAB ORCHARD WV
25827
US

IV. Provider business mailing address

PO BOX 1074
CRAB ORCHARD WV
25827-1074
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-0966
  • Fax: 304-252-4615
Mailing address:
  • Phone: 304-252-0966
  • Fax: 304-252-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number51D0235448
License Number StateWV

VIII. Authorized Official

Name: DR. BELLA ZINZUWADIA
Title or Position: OWNER
Credential: M.D.
Phone: 304-255-1300