# PRIMA MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prima Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801787817
- **Authorized official:** IYABO OMIDIWURA (ENROLLMENT MANAGER)
- **Authorized official phone:** (832) 554-6773

## Contact information

- **Practice address:** 4800 SUGAR GROVE BLVD STE 250, STAFFORD, TX 77477-2639
- **Practice address phone:** (832) 554-6773
- **Mailing address:** 4800 SUGAR GROVE BLVD STE 250, STAFFORD, TX 77477-2639
- **Mailing address phone:** (832) 554-6773

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/09/2025
- **Last updated:** 07/09/2025