Primefort Health LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

Q7009 Issued in TX

Legal business name

PRIMEFORT HEALTH LLC

Practice address

2710 Hospital Drive
Suite 114
Victoria, TX 77901-5701

Phone

(908) 220-4142

Fax

(866) 777-8553

NPI assigned

Sep 23, 2016

Organization subpart

Yes

Parent organization

PRIMEFORT HEALTH LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Opeyemi Abiodun Awe, M.D.

Title

Director

Phone

(908) 220-4142

Specialties & licenses 2

Addresses

Part of

Primefort Health LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1508315110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1879",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779021879",
            "telephone_number": "908-220-4142",
            "fax_number": "866-777-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 HOSPITAL DRIVE",
            "address_2": "SUITE 114",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779015701",
            "telephone_number": "908-220-4142",
            "fax_number": "866-777-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMEFORT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMEFORT HEALTH LLC",
        "enumeration_date": "2016-09-23",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "AWE",
        "authorized_official_first_name": "OPEYEMI",
        "authorized_official_middle_name": "ABIODUN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "908-220-4142",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q7009",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "Q7009",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.