Organization
PRIMARY CARE OF ADA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDI IVY (CREDENTIALING SPECIALIST)
(580) 272-0485
Entity
Organization
Contact information
Practice address
1705 CRADDUCK RD, ADA, OK 74820-9491
(580) 279-6313
Mailing address
1705 CRADDUCK RD STE B, ADA, OK 74820-9491
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/20/2016
Last updated
12/23/2021
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