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General NPI Number Information
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NPI Number | 1184501413
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Entity Type | Organization
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Legal Business Name | PRIME VITAL
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2257 N LOOP 336 W STE 140-246
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City | CONROE
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State | TX
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Zip | 77304-3566
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Country | US
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Telephone | 832-656-6790
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Fax |
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Provider Business Mailing Address
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Address Line | 2257 N LOOP 336 W STE 140-246
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City | CONROE
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State | TX
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Zip | 77304-3566
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Country | US
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Telephone | 832-656-6790
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARA IKE
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Credential | FNP-C
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Telephone | 832-656-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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