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General NPI Number Information
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NPI Number | 1801787817
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Entity Type | Organization
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Legal Business Name | PRIMA MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 4800 SUGAR GROVE BLVD STE 250
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City | STAFFORD
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State | TX
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Zip | 77477-2639
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Country | US
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Telephone | 832-554-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 SUGAR GROVE BLVD STE 250
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City | STAFFORD
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State | TX
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Zip | 77477-2639
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Country | US
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Telephone | 832-554-6773
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT MANAGER
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Name | IYABO OMIDIWURA
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Credential |
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Telephone | 832-554-6773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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