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General NPI Number Information
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NPI Number | 1154844348
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Entity Type | Organization
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Legal Business Name | PRYME FOOT & ANKLE CENTER PLLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 1759 BROAD PARK CIR S #205
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City | MANSFIELD
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State | TX
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Zip | 76063-7834
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Country | US
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Telephone | 682-223-2400
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Fax | 682-334-7061
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Provider Business Mailing Address
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Address Line | 1759 BROAD PARK CIR S #205
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City | MANSFIELD
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State | TX
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Zip | 76063-7834
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Country | US
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Telephone | 682-223-2400
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Fax | 682-334-7061
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Authorized Official
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Title or Position | OWNER
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Name | RANDY HAMILTON
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Credential | DMD
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Telephone | 682-223-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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