Healthcare Provider Details

I. General information

NPI: 1861509606
Provider Name (Legal Business Name): MUSKOGEE IMMEDIATE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 CHANDLER RD
MUSKOGEE OK
74403-4910
US

IV. Provider business mailing address

PO BOX 268830
OKLAHOMA CITY OK
73126-8830
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-0721
  • Fax: 405-948-6507
Mailing address:
  • Phone: 405-947-8586
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM BLAIR
Title or Position: CFO
Credential:
Phone: 918-682-0721