Healthcare Provider Details

I. General information

NPI: 1104155985
Provider Name (Legal Business Name): PRIMACARE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9031 SW 29TH ST
OKLAHOMA CITY OK
73179-2818
US

IV. Provider business mailing address

9031 SW 29TH ST
OKLAHOMA CITY OK
73179-2818
US

V. Phone/Fax

Practice location:
  • Phone: 405-512-6950
  • Fax: 405-512-6960
Mailing address:
  • Phone: 405-512-6950
  • Fax: 405-512-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRIN WEBSTER
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 405-512-6950