Prime Health & Wellness
Organization Active NPI Clinic/Center · Fayette, MS
NPI 1194387217 · NPPES record last updated Aug 4, 2020
Key facts
- NPI
- 1194387217
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- PRIME HEALTH & WELLNESS
- Practice address
- 225 Community Dr
Fayette, MS 39069-7701 - Phone
- (601) 786-8655
- Fax
- (601) 786-8656
- NPI assigned
- Jun 28, 2019
- Organization subpart
- No
Authorized official
- Name
- Cinda Perryman
- Title
- FNP
- Phone
- (601) 786-8655
Practitioners 1
-
Cinda Perryman, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2172152 | Prime Health and Wellness | Certificate of waiver | Sep 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191126003011 | MS | Part B Supplier - Clinic/Group Practice | 3577996867 |
Receives reassigned benefits from 1 practitioner Practice locations: Fayette, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
225 Community Dr
Fayette, MS 39069-7701
Mailing address
PO Box 36
Fayette, MS 39069-0036
Phone (601) 786-8655
Other providers in Fayette, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.