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General NPI Number Information
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NPI Number | 1558162685
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 11321 I30 FRONTAGE RD SUITE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72209
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Country | US
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Telephone | 501-444-2748
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Fax |
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Provider Business Mailing Address
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Address Line | 17200 CHENAL PKWY STE 300149
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City | LITTLE ROCK
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State | AR
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Zip | 72223-5958
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Country | US
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Telephone | 270-996-7871
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAITANYA MUSHAM
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Credential | MD
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Telephone | 501-444-2748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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