Healthcare Provider Details

I. General information

NPI: 1831840958
Provider Name (Legal Business Name): PRIME PHYSICIAN STAFFING 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 SE ADAMS BLVD
BARTLESVILLE OK
74006-8960
US

IV. Provider business mailing address

20 E 5TH ST STE 620
TULSA OK
74103-4441
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-0550
  • Fax:
Mailing address:
  • Phone: 918-576-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB KRAJICEK
Title or Position: MEMBER
Credential: DO
Phone: 918-576-3150