Healthcare Provider Details

I. General information

NPI: 1447577804
Provider Name (Legal Business Name): RETAIL CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 S MAY AVE
OKLAHOMA CITY OK
73170-2500
US

IV. Provider business mailing address

14024 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1006
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-3300
  • Fax:
Mailing address:
  • Phone: 405-419-8420
  • Fax: 405-419-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN KIM KING
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 405-378-3300