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General NPI Number Information
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NPI Number | 1831840958
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Entity Type | Organization
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Legal Business Name | PRIME PHYSICIAN STAFFING 3 LLC
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 6006 SE ADAMS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-8960
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Country | US
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Telephone | 918-331-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 20 E 5TH ST STE 620
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City | TULSA
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State | OK
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Zip | 74103-4441
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Country | US
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Telephone | 918-576-3150
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JACOB KRAJICEK
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Credential | DO
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Telephone | 918-576-3150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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