Provider Demographics
NPI:1407237704
Name:PRIMECARE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:PRIMECARE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:580-226-1010
Mailing Address - Street 1:1019 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1810
Mailing Address - Country:US
Mailing Address - Phone:580-490-3336
Mailing Address - Fax:580-490-3342
Practice Address - Street 1:1405 4TH AVE NW # 311
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2708
Practice Address - Country:US
Practice Address - Phone:580-490-3336
Practice Address - Fax:580-490-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty