Provider Demographics
NPI:1659855666
Name:PRIMARY CARE CENTERS OF AMERICA, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE CENTERS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-513-6334
Mailing Address - Street 1:800 W 18TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3759
Mailing Address - Country:US
Mailing Address - Phone:405-513-7257
Mailing Address - Fax:405-513-7267
Practice Address - Street 1:800 W 18TH ST STE 130
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3759
Practice Address - Country:US
Practice Address - Phone:405-513-7257
Practice Address - Fax:405-513-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1659855666OtherNPI