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General NPI Number Information
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NPI Number | 1205435377
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Entity Type | Organization
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Legal Business Name | CLINICAL SERVICES OF OKLAHOMA LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 14 S MISSION ST
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City | SAPULPA
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State | OK
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Zip | 74066-4634
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Country | US
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Telephone | 918-227-2010
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Fax | 918-227-2843
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Provider Business Mailing Address
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Address Line | 14 S MISSION ST
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City | SAPULPA
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State | OK
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Zip | 74066-4634
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Country | US
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Telephone | 918-227-2010
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Fax | 918-227-2843
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | TRAVIS BRETT WOLFF
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Credential |
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Telephone | 918-227-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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