Healthcare Provider Details

I. General information

NPI: 1336364181
Provider Name (Legal Business Name): SLATER MEDICAL ARTS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEDICAL DR
GUYMON OK
73942-3606
US

IV. Provider business mailing address

PO BOX 100
GUYMON OK
73942-0100
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-6506
  • Fax: 580-338-3121
Mailing address:
  • Phone: 580-338-6506
  • Fax: 580-338-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2812
License Number StateOK

VIII. Authorized Official

Name: DR. CHRIS B SLATER
Title or Position: OWNER
Credential: DO
Phone: 580-338-6506