Provider Demographics
NPI:1730230954
Name:PRIME HOSPITALIST GROUP PA
Entity type:Organization
Organization Name:PRIME HOSPITALIST GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AAMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-909-0427
Mailing Address - Street 1:PO BOX 690818
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0818
Mailing Address - Country:US
Mailing Address - Phone:407-909-0427
Mailing Address - Fax:407-909-1472
Practice Address - Street 1:9151 POINT CYPRESS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5478
Practice Address - Country:US
Practice Address - Phone:407-909-0427
Practice Address - Fax:407-909-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261530400Medicaid
FL261530400Medicaid