Provider Demographics
NPI:1831840958
Name:PRIME PHYSICIAN STAFFING 3 LLC
Entity type:Organization
Organization Name:PRIME PHYSICIAN STAFFING 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
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 STE 620
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-4441
Mailing Address - Country:US
Mailing Address - Phone:918-576-3150
Mailing Address - Fax:
Practice Address - Street 1:6006 SE ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8960
Practice Address - Country:US
Practice Address - Phone:918-331-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty