Provider Demographics
NPI:1699978593
Name:PRIMARY CARE ASSOCIATES OF NORMAN
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF NORMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-928-2050
Mailing Address - Street 1:1125 NORTH PORTER
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071
Mailing Address - Country:US
Mailing Address - Phone:405-928-2050
Mailing Address - Fax:405-928-2054
Practice Address - Street 1:1125 NORTH PORTER
Practice Address - Street 2:SUITE 202
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-928-2050
Practice Address - Fax:405-928-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100252400BMedicaid
OKH23474Medicare UPIN
OK241323902Medicare ID - Type Unspecified