=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265811905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMA GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16303 LAZY RIDGE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77053-4654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-248-2832
-----------------------------------------------------
Fax | 281-416-1613
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16303 LAZY RIDGE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77053-4654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-248-2832
-----------------------------------------------------
Fax | 281-416-1613
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. TOKE O OGUNDIYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-248-2832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------