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Organization

GRAND PRIMARY CARE CLINICS

Active
Parent organization
KIMBACO, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
KIMBACO, LLC
Authorized official
MR. JEFF J HUNTER DPH (OWNER)
(405) 418-2929
Entity
Organization

Contact information

Practice address
5401 N PORTLAND AVE, SUITE 270, OKLAHOMA CITY, OK 73112-2121
(405) 605-0108
(405) 463-0120
Mailing address
5401 N PORTLAND AVE, SUITE 270, OKLAHOMA CITY, OK 73112-2121
(405) 605-0108
(405) 463-0120

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
OK
Enumeration date
09/17/2016
Last updated
03/28/2017
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