Healthcare Provider Details

I. General information

NPI: 1467560250
Provider Name (Legal Business Name): CLINICAL CARE CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST
OWASSO OK
74055-3108
US

IV. Provider business mailing address

P.O. BOX 1204
OWASSO OK
74055-5815
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-9111
  • Fax: 918-274-1745
Mailing address:
  • Phone: 918-274-9111
  • Fax: 918-274-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number11371
License Number StateOK

VIII. Authorized Official

Name: MRS. KATHY MAY CAMPBELL
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 918-274-9111