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General NPI Number Information
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NPI Number | 1447699178
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Entity Type | Organization
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Legal Business Name | PRIME ASSURE LLC
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Dates
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Enumeration Date | 06/16/2013
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1060 WINTER LN
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City | TALLAHASSEE
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State | FL
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Zip | 32311-1267
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Country | US
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Telephone | 850-524-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 WINTER LN
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City | TALLAHASSEE
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State | FL
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Zip | 32311-1267
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Country | US
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Telephone | 850-852-4157
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ULOMA D ONUBOGU
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Credential | PHD., ARNP
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Telephone | 85085241577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2721822
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2721822
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License Number State | FL
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