MEDICARE: FIRST MED PRIMARY CARE 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1447899778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST MED PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	1221 N KELLY AVE
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-4865
Country	:	US
Telephone Number	:	405-691-3100
Fax Number	:	405-691-3106

Provider Business Practice Location Address
First Line	:	1142 SW 104TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139
Country	:	US
Telephone Number	:	405-691-3100
Fax Number	:	405-691-3106

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	TODD KEE
Credential	:
Telephone Number	:	405-691-3100

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	03/06/2020

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