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General NPI Number Information
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NPI Number | 1275953820
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE MEDICAL CLINIC PLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 13600 PRAIRIE VIEW LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-5917
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Country | US
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Telephone | 888-330-7831
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Fax | 888-330-7831
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Provider Business Mailing Address
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Address Line | 13600 PRAIRIE VIEW LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-5917
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Country | US
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Telephone | 888-330-7831
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Fax | 888-330-7831
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL SHANE JOHNSON
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Credential | M.D.
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Telephone | 810-941-8245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 30380
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License Number State | OK
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