Provider Demographics
NPI:1699163923
Name:PRIMWAY MEDICAL, PLLC
Entity type:Organization
Organization Name:PRIMWAY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADENIYI
Authorized Official - Middle Name:O
Authorized Official - Last Name:IGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-688-9190
Mailing Address - Street 1:11345 ALAMO RANCH PKWY
Mailing Address - Street 2:STE. 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6440
Mailing Address - Country:US
Mailing Address - Phone:210-688-9190
Mailing Address - Fax:877-936-8202
Practice Address - Street 1:11345 ALAMO RANCH PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6440
Practice Address - Country:US
Practice Address - Phone:210-688-9190
Practice Address - Fax:877-936-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty