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General NPI Number Information
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NPI Number | 1861905952
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Entity Type | Organization
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Legal Business Name | PRIME MED LLC
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 11/10/2017
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Provider Practice Location Address
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Address Line | 8962 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9648
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Country | US
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Telephone | 317-385-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 11650 OLIO RD STE 1000-324
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City | FISHERS
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State | IN
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Zip | 46037-7619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ERIKA TOLLETT
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Credential |
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Telephone | 317-385-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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