Healthcare Provider Details

I. General information

NPI: 1114276425
Provider Name (Legal Business Name): EASTERN OKLAHOMA MEDICAL CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NORTH MAIN
GORE OK
74435-0479
US

IV. Provider business mailing address

PO BOX 1100
GORE OK
74435-0479
US

V. Phone/Fax

Practice location:
  • Phone: 918-489-5757
  • Fax: 918-489-5411
Mailing address:
  • Phone: 918-489-5757
  • Fax: 918-489-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLY F KEATHLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-489-5757