Prima Medical Group, Inc.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

G073451 Issued in CA

Legal business name

PRIMA MEDICAL GROUP, INC.

Practice address

4000 Civic Center Dr
200
San Rafael, CA 94903-4171

Phone

(415) 492-3333

NPI assigned

Feb 20, 2008

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Tax ID family

Prima Medical Group - Drakes Landing2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prima Medical Group, Inc.

  • Non-Pharmacy Dispensing Site
  • Greenbrae, CA
  • NPI 1528230570
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1124297452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR",
            "address_2": "200",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034171",
            "telephone_number": "415-492-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-02-20",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G073451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Preventive Medical Center of Marin Inc
• Paul Pribuss, PAUL PRIBUSS
• Marian Elizabeth Price, MFT
• Maria Jose Prieto de Estebecorena, PH,D.
• Prima Medical Group-Terra Linda
• Prima Medical Group, Inc.
• Brianna Prince, RDH
• Stephen Lochrane Prince, ICADC
• Ann Piper Pring, PHD
• Stephanie Pritzkow

• Non-Pharmacy Dispensing Site in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.