Healthcare Provider Details

I. General information

NPI: 1982257812
Provider Name (Legal Business Name): TEAM CLINICS AH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ORIENT AVE
CLINTON OK
73601-2751
US

IV. Provider business mailing address

3112 COOKE WAY
OKLAHOMA CITY OK
73179-2401
US

V. Phone/Fax

Practice location:
  • Phone: 405-546-4130
  • Fax:
Mailing address:
  • Phone: 405-546-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREVOR NUTT
Title or Position: CEO
Credential:
Phone: 405-546-4130