Healthcare Provider Details

I. General information

NPI: 1952477093
Provider Name (Legal Business Name): URGENT CARE CLINIC OF ATOKA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S. VIRGINIA AVE
ATOKA OK
74525-3246
US

IV. Provider business mailing address

1510 S. VIRGINIA AVE
ATOKA OK
74525-3246
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-6621
  • Fax: 580-889-3602
Mailing address:
  • Phone: 580-889-6621
  • Fax: 580-889-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1806
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3521
License Number StateOK

VIII. Authorized Official

Name: DR. NOEL W EMERSON
Title or Position: OWNER/PRESIDENT
Credential: DO
Phone: 580-889-6621