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General NPI Number Information
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NPI Number | 1407237704
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Entity Type | Organization
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Legal Business Name | PRIMECARE FAMILY CLINIC LLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 1405 4TH AVE NW # 311
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City | ARDMORE
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State | OK
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Zip | 73401-2708
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Country | US
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Telephone | 580-490-3336
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Fax | 580-490-3342
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Provider Business Mailing Address
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Address Line | 1019 15TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1810
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Country | US
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Telephone | 580-490-3336
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Fax | 580-490-3342
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. VALERIE MARIE MALONE
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Credential | CPC
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Telephone | 580-226-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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