Healthcare Provider Details

I. General information

NPI: 1558563189
Provider Name (Legal Business Name): PARTNERS IN HEALTH MULTICARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 E HIGHWAY 37
TUTTLE OK
73089-8581
US

IV. Provider business mailing address

PO BOX 309
TUTTLE OK
73089-0309
US

V. Phone/Fax

Practice location:
  • Phone: 405-973-4306
  • Fax:
Mailing address:
  • Phone: 405-973-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0062152
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0054748
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1073594032
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerNPI
# 2
Identifier1942236690
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerNPI

VIII. Authorized Official

Name: MR. CARL LAFFOON
Title or Position: CEO, OWNER
Credential: NP
Phone: 405-973-4306