=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730781311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRYME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2020
-----------------------------------------------------
Last Update Date | 11/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 N UNIVERSITY DR STE E200
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-221-8397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3265 TRAFALGER CIR
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-5333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-221-8397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ANNA K RUBIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-221-8397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------