Healthcare Provider Details

I. General information

NPI: 1720033087
Provider Name (Legal Business Name): NEON CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W UNIVERSITY BLVD
DURANT OK
74701-3006
US

IV. Provider business mailing address

PO BOX 15268
ASHEVILLE NC
28813-0268
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-3080
  • Fax:
Mailing address:
  • Phone: 828-250-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AMY FORD
Title or Position: PRESIDENT
Credential:
Phone: 903-640-7317