Organization
EDMOND PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BODINE PHYSICIAN ASSISTANT (OWNER/CEO)
(636) 485-0731
Entity
Organization
Contact information
Practice address
200 N BRYANT AVE STE 105, EDMOND, OK 73034-6273
(405) 300-8964
Mailing address
200 N BRYANT AVE STE 105, EDMOND, OK 73034-6273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
05/14/2025
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