Basic Information
| Provider Information | |||||||||
| NPI: | 1295088433 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME HEALTHCARE SERVICES PAMPA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 W 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | PAMPA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790652814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066635600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 W 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | PAMPA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790652814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066635600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2012 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | SARRAO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8066635600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.