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General NPI Number Information
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NPI Number | 1164887972
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Entity Type | Organization
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Legal Business Name | PRIMEBODY
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 11611 E SAHUARO DR SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-3163
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Country | US
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Telephone | 602-732-4418
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Fax | 602-569-9027
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Provider Business Mailing Address
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Address Line | 14500 N NORTHSIGHT BLVD SUITE 200
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3658
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Country | US
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Telephone | 602-732-4418
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Fax | 602-569-9027
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Authorized Official
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Title or Position | OWNER
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Name | MR. NICK GLIMCHER
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Credential |
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Telephone | 602-732-4412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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