Healthcare Provider Details

I. General information

NPI: 1104165331
Provider Name (Legal Business Name): IMMEDIATE CARE OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E 33RD ST
EDMOND OK
73013-6307
US

IV. Provider business mailing address

PO BOX 721776
NORMAN OK
73070-8360
US

V. Phone/Fax

Practice location:
  • Phone: 405-513-6300
  • Fax: 405-513-6301
Mailing address:
  • Phone: 405-600-6869
  • Fax: 405-600-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN M PENWELL
Title or Position: COM
Credential: D.O.
Phone: 405-600-6869