Provider Demographics
NPI:1063153369
Name:PRIME MEDICAL GROUP CORP
Entity type:Organization
Organization Name:PRIME MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:AWAD
Authorized Official - Last Name:ABOUHOULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-307-5490
Mailing Address - Street 1:2621 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8206
Mailing Address - Country:US
Mailing Address - Phone:918-307-5490
Mailing Address - Fax:
Practice Address - Street 1:2621 E 38TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-8206
Practice Address - Country:US
Practice Address - Phone:918-307-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty