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General NPI Number Information
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NPI Number | 1215787700
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Entity Type | Organization
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Legal Business Name | PRIME TIME PHYSICIANS, LLC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 217 W REED ST STE A5
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City | MOBERLY
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State | MO
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Zip | 65270
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Country | US
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Telephone | 573-268-5725
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Fax | 877-673-1509
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Provider Business Mailing Address
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Address Line | 1605 KEEGAN CT
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City | COLUMBIA
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State | MO
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Zip | 65203-6252
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Country | US
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Telephone | 573-268-5725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYAAZ HABIBULLAH
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Credential | MD
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Telephone | 573-268-5725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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