Organization
PRIMETIME MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PELSHA DARIUS (CEO)
(954) 512-0522
Entity
Organization
Contact information
Practice address
1975 E SUNRISE BLVD STE 501, FORT LAUDERDALE, FL 33304-1410
(954) 512-0522
Mailing address
1975 E SUNRISE BLVD STE 501, FORT LAUDERDALE, FL 33304-1410
(954) 512-0522
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D620670872821
DRIVERS LICENSE
FL
Enumeration date
08/18/2020
Last updated
08/18/2020
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