Provider Demographics
NPI:1730210055
Name:PRIME CARE NURSING
Entity type:Organization
Organization Name:PRIME CARE NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-849-3019
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38702-0852
Mailing Address - Country:US
Mailing Address - Phone:662-335-4298
Mailing Address - Fax:662-335-8298
Practice Address - Street 1:222 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4203
Practice Address - Country:US
Practice Address - Phone:662-335-4298
Practice Address - Fax:662-335-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 164W00000X, 376J00000X, 376K00000X
MSR513563251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770606Medicaid
MS00770096Medicaid
MS09477569Medicaid
MS00770095Medicaid
MS00770605Medicaid