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General NPI Number Information
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NPI Number | 1093312548
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Entity Type | Organization
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Legal Business Name | PRIME HEALTH ASSOCIATES, PLLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 2511 ALEXA AVE
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City | EDMOND
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State | OK
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Zip | 73034-3458
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Country | US
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Telephone | 405-822-0130
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Fax |
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Provider Business Mailing Address
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Address Line | 2511 ALEXA AVE
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City | EDMOND
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State | OK
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Zip | 73034-3458
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Country | US
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Telephone | 405-822-0130
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | KEVIN WHITE
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Credential | MD
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Telephone | 405-822-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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