Provider Demographics
NPI:1275017766
Name:PRIME PHYSICIAN STAFFING PLLC
Entity Type:Organization
Organization Name:PRIME PHYSICIAN STAFFING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJICEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-576-3150
Mailing Address - Street 1:20 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-4439
Mailing Address - Country:US
Mailing Address - Phone:918-576-3150
Mailing Address - Fax:
Practice Address - Street 1:1801 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5145
Practice Address - Country:US
Practice Address - Phone:580-821-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty