Provider Demographics
NPI:1851988760
Name:PRIME ADDICTION MEDICINE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PRIME ADDICTION MEDICINE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OKECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:OBUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-621-4604
Mailing Address - Street 1:13902 LITTLE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1958
Mailing Address - Country:US
Mailing Address - Phone:214-621-4604
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-431-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty