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General NPI Number Information
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NPI Number | 1710870696
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE IOD
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 6 NORTHWESTERN DR STE 101
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3416
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Country | US
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Telephone | 860-580-5656
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Fax | 860-580-5799
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Provider Business Mailing Address
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Address Line | 6 NORTHWESTERN DR STE 101
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3416
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Country | US
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Telephone | 860-580-5656
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Fax | 860-580-5799
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Authorized Official
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Title or Position | DIRECTOR OF CODING AND COMPLIANCE
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Name | SERENA ANN KIMBALL
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Credential |
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Telephone | 860-263-0256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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