Healthcare Provider Details

I. General information

NPI: 1790912491
Provider Name (Legal Business Name): IMMEDIATE CARE OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 W TECUMSEH RD STE 125
NORMAN OK
73072-1857
US

IV. Provider business mailing address

5701 SE 74TH ST STE E
OKLAHOMA CITY OK
73135-1110
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KEVIN PENWELL
Title or Position: COM
Credential: DO
Phone: 405-735-2370