MEDICARE: PRIMA MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G73451	CA

General Provider Information

NPI Number	:	1154377489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMA MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3 HAMILTON LANDING
Second Line	:	#160
City	:	NOVATO
State	:	CA
Zip	:	94948
Country	:	US
Telephone Number	:	415-884-1840
Fax Number	:	415-884-3510

Provider Business Practice Location Address
First Line	:	4000 CIVIC CENTER DR
Second Line	:	#200B
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-4171
Country	:	US
Telephone Number	:	415-492-3333
Fax Number	:	415-492-3425

Authorized Official
Title or Position	:	PHYSICIAN/MEDICAL DIRECTOR
Name	:	MR. JOSEPH A HABRIS
Credential	:	M.D
Telephone Number	:	415-492-3333

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/04/2008

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