=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992668412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME SCREENING SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 E NORTH ST STE AA107
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-202-0859
-----------------------------------------------------
Fax | 864-572-4027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 E NORTH ST STE AA107
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-202-0859
-----------------------------------------------------
Fax | 864-572-4027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | MRS. KAREN BURNSIDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-202-0859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------