Healthcare Provider Details

I. General information

NPI: 1558816850
Provider Name (Legal Business Name): SPECTRUM HEALTHCARE SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N CLASSEN BLVD STE A
OKLAHOMA CITY OK
73118-2434
US

IV. Provider business mailing address

PO BOX 6276
NORMAN OK
73070-6276
US

V. Phone/Fax

Practice location:
  • Phone: 405-769-5749
  • Fax: 405-493-8506
Mailing address:
  • Phone: 405-768-5749
  • Fax: 405-493-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26716
License Number StateOK

VIII. Authorized Official

Name: MICHELLE CLARK
Title or Position: COO
Credential:
Phone: 405-768-5749