MEDICARE: PRIMED HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1144830506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMED HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	822 W RANDOLPH AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3834
Country	:	US
Telephone Number	:	580-599-0272
Fax Number	:	580-603-8602

Provider Business Practice Location Address
First Line	:	822 W RANDOLPH AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3834
Country	:	US
Telephone Number	:	580-599-0272
Fax Number	:	580-603-8602

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN K BUSHMAN
Credential	:	DO
Telephone Number	:	580-599-0272

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	05/31/2026

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