Provider Demographics
NPI:1609344233
Name:PRIME CARE PEDIATRIC SERVICES
Entity type:Organization
Organization Name:PRIME CARE PEDIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-402-1151
Mailing Address - Street 1:1609 MONTAGE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-5540
Mailing Address - Country:US
Mailing Address - Phone:214-402-1151
Mailing Address - Fax:
Practice Address - Street 1:1609 MONTAGE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-5540
Practice Address - Country:US
Practice Address - Phone:214-402-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health