Healthcare Provider Details

I. General information

NPI: 1245632264
Provider Name (Legal Business Name): TODAY CLINIC WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N MERIDIAN AVE
OKLAHOMA CITY OK
73107-5095
US

IV. Provider business mailing address

701 NE 36TH ST
OKLAHOMA CITY OK
73105-7203
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-0611
  • Fax: 405-631-0811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT CAUTHEN
Title or Position: MEMBER
Credential:
Phone: 405-740-1968