Healthcare Provider Details

I. General information

NPI: 1124932488
Provider Name (Legal Business Name): DWM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 N 4TH ST STE F
PONCA CITY OK
74601
US

IV. Provider business mailing address

722 N 4TH ST STE F
PONCA CITY OK
74601
US

V. Phone/Fax

Practice location:
  • Phone: 888-446-4118
  • Fax:
Mailing address:
  • Phone: 888-446-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VAMSI KRISHNA KATTA
Title or Position: MANAGER
Credential:
Phone: 888-446-4118