PRIME MEDICAL GROUP PLLC (NPI# 1790384808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790384808 |
| Entity Type | Organization |
| Organization Name | PRIME MEDICAL GROUP PLLC |
| Practice Address |
625 United Dr Ste 320 Conway AR 72032-7828 |
| Mailing Address |
9601 Baptist Health Dr Ste 690 Little Rock AR 72205-6328 |
| Practice Telephone | 5012278422 |
| Practice Fax Number | 5013586519 |
| Mailing Telephone | 5012278422 |
| Mailing Fax Number | 5015372399 |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |
| Authorized Official Name | RAY KOHLER PARKER (PHYSICIAN) |
| Authorized Official Telephone | 5012278422 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIME MEDICAL GROUP PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 239910002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1649879750 | Prime Medical Group Pllc | Dermatology | 5 Medical Park Dr Ste 200, Benton, AR 72015-3732 | 2020-10-20 |
| 1528667672 | Prime Medical Group Pllc | Dermatology | 315 Section Line Rd Ste A&b, Hot Springs, AR 71913-6480 | 2020-10-20 |
| 1942809058 | Prime Medical Group Pllc | Dermatology | 16115 Saint Vincent Way Ste 300, Little Rock, AR 72223-3000 | 2020-10-20 |
| 1790384899 | Prime Medical Group Pllc | Dermatology | 353 Cash Rd Sw, Camden, AR 71701-3704 | 2020-10-20 |
| 1427605153 | Prime Medical Group Pllc | Dermatology | 9601 Baptist Health Dr Ste 690, Little Rock, AR 72205-6328 | 2019-08-19 |
| Street Address |
625 UNITED DR STE 320 |
| City | CONWAY |
| State | AR |
| Zip Code | 72032-7828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789843 | Amelia S Lasater | Pharmacist | 1155 Hwy 65n, Conway, AR 72032 | 2020-10-28 |
| 1619584604 | Danyelle Durocher | Occupational Therapist | 1301 North Museum Rd, Conway, AR 72032 | 2020-09-24 |
| 1780222174 | Eric Herman Boxnick | Pharmacist | 101 West Oak Street, Conway, AR 72032 | 2019-12-16 |
| 1932746070 | Habilitation Center, LLC | Psychiatric Residential Treatment Facility | 161 Skunk Hollow Road, Conway, AR 72032 | 2019-12-09 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1750821625 | Luke Osborne | Physical Therapy Assistant | 1 Thomas Ln, Conway, AR 72032 | 2017-02-27 |
| 1639620099 | Sam's West, Inc. | Technician/Technologist | 1250 South Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1922559343 | Sam's West, Inc. | Durable Medical Equipment & Medical Supplies | 1250 Sourth Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1639629108 | Posture Store | Durable Medical Equipment & Medical Supplies | 3900 Dave Ward Dr., Suite 1900-130, Conway, AR 72032 | 2016-10-09 |
| Find all providers in zip 72032 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588643563 | Thomas Floyd Hudson IIi | Dermatology | 9 Medical Lane, Conway, AR 72034 | 2006-01-10 |
| 1245411891 | Tom Hudson LLC | Dermatology | 9 Medical Lane, Conway, AR 72034 | 2007-11-23 |
| 1639134067 | Russell Dermatology of Conway, Pllc | Dermatology | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2006-04-19 |
| 1457330011 | Shelley W Russell | Dermatology | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2006-01-12 |
| 1033198510 | Eric Brian Russell | Dermatology | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2006-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1649879750 | Prime Medical Group Pllc | Dermatology | 5 Medical Park Dr Ste 200, Benton, AR 72015-3732 | 2020-10-20 |
| 1528667672 | Prime Medical Group Pllc | Dermatology | 315 Section Line Rd Ste A&b, Hot Springs, AR 71913-6480 | 2020-10-20 |
| 1487064473 | Laura Raquel Battle | Dermatology | 500 South 52nd Street, Rogers, AR 72758-7275 | 2014-04-30 |
| 1174942528 | Jacey Tanner Guthrie | Dermatology | 4200 N Rodney Parham Rd Ste 202, Little Rock, AR 72212 | 2014-04-14 |
| 1801215751 | Allison Noel Hood | Dermatology | 9601 Baptist Health Drive Suite 860, Little Rock, AR 72205 | 2014-04-08 |
| 1710229141 | Mallory Hurst | Dermatology | 800 S Church St Ste 202, Jonesboro, AR 72401 | 2013-03-24 |
| 1720333990 | Vivian Shi | Dermatology | 4018 W Capitol Ave, Little Rock, AR 72205 | 2012-07-13 |
| 1295098440 | Garrett James Nelson | Dermatology | 9601 Baptist Health Dr Ste 690, Little Rock, AR 72205-6328 | 2012-06-22 |
| 1922398577 | Megan Suzanne Evans | Dermatology | 1 Childrens Way # 576, Little Rock, AR 72202-3500 | 2011-04-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.