| Prime Group Medical Clinic Llc | |
|
3224 I 30 Ste 148 Mesquite TX 75150-2693 | |
| (469) 438-4493 | |
| Not Available |
| Full Name | Prime Group Medical Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3224 I 30 Ste 148, Mesquite, Texas |
| Authorized Official Name and Position | Jessie Mendiola (MANAGER) |
| Authorized Official Contact | 4694384493 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Group Medical Clinic Llc 3224 I 30 Ste 148 Mesquite TX 75150-2693 Ph: (469) 438-4493 | Prime Group Medical Clinic Llc 3224 I 30 Ste 148 Mesquite TX 75150-2693 Ph: (469) 438-4493 |
| NPI Number | 1629749783 |
|---|---|
| Provider Enumeration Date | 09/27/2021 |
| Last Update Date | 06/21/2023 |
| Medicare PECOS PAC ID | 2062941115 |
|---|---|
| Medicare Enrollment ID | O20250119000070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629749783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Angelina A Rivero |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1033113386 PECOS PAC ID: 9335118504 Enrollment ID: I20040927000021 |
| Provider Name | Cristina R Aseron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811070436 PECOS PAC ID: 4284778101 Enrollment ID: I20100216000539 |
| Provider Name | Pedro Daniel Paez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235765181 PECOS PAC ID: 7315324753 Enrollment ID: I20220524002212 |
| Provider Name | Yun J Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649603846 PECOS PAC ID: 6709326374 Enrollment ID: I20240910001834 |
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