Healthcare Provider Details

I. General information

NPI: 1154890853
Provider Name (Legal Business Name): MEDNOW PRIMARY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7127 S OLYMPIA AVE
TULSA OK
74132-1856
US

IV. Provider business mailing address

PO BOX 3940
BROKEN ARROW OK
74013-3940
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-9500
  • Fax: 918-665-9512
Mailing address:
  • Phone: 918-286-3730
  • Fax: 918-893-2877

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: CONNIE CLAMPITT
Title or Position: BILLING DIRECTOR
Credential:
Phone: 918-286-3730