Healthcare Provider Details

I. General information

NPI: 1285864397
Provider Name (Legal Business Name): SIMPLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SW 59TH ST
OKLAHOMA CITY OK
73109-8303
US

IV. Provider business mailing address

415 SW 59TH ST
OKLAHOMA CITY OK
73109-8303
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number25197
License Number StateOK

VIII. Authorized Official

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