Provider Demographics
NPI:1730906728
Name:PRIME PROFESSIONALS MEDICAL LLC
Entity type:Organization
Organization Name:PRIME PROFESSIONALS MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEQUESHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITELAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:205-887-6409
Mailing Address - Street 1:3079 PALISADES CT STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3457
Mailing Address - Country:US
Mailing Address - Phone:205-887-6409
Mailing Address - Fax:205-409-7733
Practice Address - Street 1:12 JUANITA DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3210
Practice Address - Country:US
Practice Address - Phone:659-333-2458
Practice Address - Fax:205-409-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health