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General NPI Number Information
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NPI Number | 1962809947
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 201 NW R D MIZE RD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2513
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Country | US
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Telephone | 816-228-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 201 NW R D MIZE RD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2513
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Country | US
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Telephone | 816-228-5900
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN/PRESIDENT
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Name | PREM REDDY
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Credential | M.D.
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Telephone | 909-235-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 403-20
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License Number State | MO
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