Healthcare Provider Details

I. General information

NPI: 1770927790
Provider Name (Legal Business Name): PREVENT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2013
Last Update Date: 04/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N CLASSEN BLVD SUITE 203
OKLAHOMA CITY OK
73118-4834
US

IV. Provider business mailing address

2410 W MEMORIAL RD STE C #156
OKLAHOMA CITY OK
73134-8047
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-8102
  • Fax: 806-209-0000
Mailing address:
  • Phone: 806-239-6862
  • Fax: 806-209-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MURGAI
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 806-239-6862