Healthcare Provider Details

I. General information

NPI: 1851528541
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: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 24TH AVE NW
NORMAN OK
73069-6314
US

IV. Provider business mailing address

800 24TH AVE NW
NORMAN OK
73069-6314
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-7100
  • 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