Healthcare Provider Details

I. General information

NPI: 1548697550
Provider Name (Legal Business Name): LMC MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 W SHAWNEE ST SUITE A
MUSKOGEE OK
74401-3511
US

IV. Provider business mailing address

932 W SHAWNEE ST SUITE A
MUSKOGEE OK
74401-3511
US

V. Phone/Fax

Practice location:
  • Phone: 918-453-1234
  • Fax: 918-453-9107
Mailing address:
  • Phone: 918-453-1234
  • Fax: 918-453-9107

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: TRACEY W CHILDERS
Title or Position: OWNER
Credential: D.O.
Phone: 918-453-1234