Healthcare Provider Details

I. General information

NPI: 1902965411
Provider Name (Legal Business Name): PREMIER INTERNAL MEDICINE AND PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W 3RD ST STE 101
ELK CITY OK
73644-5160
US

IV. Provider business mailing address

1710 W 3RD ST STE 101
ELK CITY OK
73644-5160
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-3781
  • Fax: 580-225-4105
Mailing address:
  • Phone: 580-225-3781
  • Fax: 580-225-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25395
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25395
License Number StateOK

VIII. Authorized Official

Name: ANDRE R MAY
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 580-225-3781