Organization
PHOENIX PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIKO KOLIASTASIS (CEO)
(918) 636-3930
Entity
Organization
Contact information
Practice address
557 HARRISON ST, PAWNEE, OK 74058-2566
(918) 762-5050
(877) 515-8550
Mailing address
209 N OAK ST, SALLISAW, OK 74955-4639
(918) 503-6276
(918) 503-6294
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/01/2018
Last updated
01/08/2020
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