Prime Healthcare Services Mesquite LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PRIME HEALTHCARE SERVICES MESQUITE LLC

Doing business as

Dallas Regional Outpatient Pharmacy

Practice address

1011 N Galloway Ave # Cl120
Mesquite, TX 75149-2433

Phone

(214) 320-7040

NPI assigned

Feb 13, 2020

Organization subpart

No

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

Authorized official

Name

Christopher Doan

Title

Managing Associate General Counsel

Phone

(310) 259-4706

Specialties & licenses 1

Addresses

Other names 1

• Dallas Regional Outpatient Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Prime Healthcare Services Mesquite LLC

  • General Acute Care Hospital
  • Mesquite, TX
  • NPI 1790174860

  4385965870

  Same PAC ID

Locations

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1780217158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 N GALLOWAY AVE # CL120",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751492433",
            "telephone_number": "214-320-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N GALLOWAY AVE # CL120",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751492433",
            "telephone_number": "214-320-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES MESQUITE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dallas Regional Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.