=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265158125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THUNDER HEALTH & URGENT CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2022
-----------------------------------------------------
Last Update Date | 11/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1354 E 15TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-5029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-861-0224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1632 CAMDEN WAY
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-926-0353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. LAURA MORENO
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 405-861-0224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------