Healthcare Provider Details

I. General information

NPI: 1548434160
Provider Name (Legal Business Name): L4 CLINICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N COMANCHE AVE
WARR ACRES OK
73132-6646
US

IV. Provider business mailing address

7301 N COMANCHE AVE
WARR ACRES OK
73132-6646
US

V. Phone/Fax

Practice location:
  • Phone: 405-728-2100
  • Fax: 405-728-2244
Mailing address:
  • Phone: 405-728-2100
  • Fax: 405-728-2244

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: DAVID LOFTIS
Title or Position: OWNER/MANAGER
Credential:
Phone: 405-728-2100