Organization
PRIMARY CARE CENTERS OF AMERICA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE A KOENIG (OFFICE MANAGER)
(405) 513-6334
Entity
Organization
Contact information
Practice address
800 W 18TH ST STE 130, EDMOND, OK 73013-3759
(405) 513-7257
(405) 513-7267
Mailing address
800 W 18TH ST STE 130, EDMOND, OK 73013-3759
(405) 513-7257
(405) 513-7267
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659855666
NPI
OK
Enumeration date
09/17/2018
Last updated
01/16/2019
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