Provider Demographics
NPI:1548788698
Name:TOTAL PRIMARY CARE PC
Entity type:Organization
Organization Name:TOTAL PRIMARY CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN PMHNP DNP
Authorized Official - Phone:405-470-7947
Mailing Address - Street 1:6301 N MERIDIAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1267
Mailing Address - Country:US
Mailing Address - Phone:405-470-7947
Mailing Address - Fax:
Practice Address - Street 1:6301 N MERIDIAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1267
Practice Address - Country:US
Practice Address - Phone:405-470-7947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200769470AMedicaid