MEDICARE: TEAM CLINICS AH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386262335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM CLINICS AH LLC

Provider Business Mailing Address
First Line	:	3112 COOKE WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-2401
Country	:	US
Telephone Number	:	405-546-4130
Fax Number	:	405-600-6978

Provider Business Practice Location Address
First Line	:	405 E RICHMOND ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5642
Country	:	US
Telephone Number	:	405-546-4130
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TREVOR NUTT
Credential	:
Telephone Number	:	405-546-4130

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	06/22/2021

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Directions to “TEAM CLINICS AH LLC ” Practice Location

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