Healthcare Provider Details

I. General information

NPI: 1285765727
Provider Name (Legal Business Name): MINUTECLINIC DIAGNOSTIC OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S BRYANT AVE
EDMOND OK
73013-6028
US

IV. Provider business mailing address

PO BOX 772 MINUTECLINIC CREDENTIALING-MC2295
WOONSOCKET RI
02895-0784
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 401-770-1768
  • Fax: 401-652-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PINCINCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-770-3813