Healthcare Provider Details

I. General information

NPI: 1801787817
Provider Name (Legal Business Name): PRIMA MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SUGAR GROVE BLVD STE 250
STAFFORD TX
77477-2639
US

IV. Provider business mailing address

4800 SUGAR GROVE BLVD STE 250
STAFFORD TX
77477-2639
US

V. Phone/Fax

Practice location:
  • Phone: 832-554-6773
  • Fax:
Mailing address:
  • Phone: 832-554-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: IYABO OMIDIWURA
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 832-554-6773