NPIMap

Organization Active NPI

Prime Medical Clinic, PLC

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1679832729
Registry record updated Jul 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP1483 Issued in AZ
Legal business name
PRIME MEDICAL CLINIC, PLC
Practice address
3104 E Indian School Rd
Suite 110
Phoenix, AZ 85016-6889
Phone
(602) 840-3584
Fax
(602) 957-2184
NPI assigned
May 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2014

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

Authorized official

Name
Dr. Patric Schine
Title
Medical Director
Phone
(602) 840-3584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X AP1483 AZ Primary

Addresses

Primary practice location

3104 E Indian School Rd
Suite 110
Phoenix, AZ 85016-6889

Mailing address

5150 N 16TH St
Suite B232
Phoenix, AZ 85016-3925
Phone (602) 840-3584

Other identifiers 1

IdentifierTypeStateIssuer
729130MedicaidAZ

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1679832729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N 16TH ST",
            "address_2": "SUITE B232",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850163925",
            "telephone_number": "602-840-3584",
            "fax_number": "602-957-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 E INDIAN SCHOOL RD",
            "address_2": "SUITE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850166889",
            "telephone_number": "602-840-3584",
            "fax_number": "602-957-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL CLINIC, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2014-07-10",
        "status": "A",
        "authorized_official_last_name": "SCHINE",
        "authorized_official_first_name": "PATRIC",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "602-840-3584",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP1483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "729130",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; 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.