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General NPI Number Information
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NPI Number | 1386970200
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Entity Type | Organization
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Legal Business Name | ARBUCKLE INTERNAL MEDICINE GROUP,PLLC
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 921 W 11TH ST STE 2
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City | SULPHUR
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State | OK
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Zip | 73086-4459
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Country | US
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Telephone | 580-622-2353
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Fax | 580-622-2351
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Provider Business Mailing Address
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Address Line | 921 W 11TH ST STE 2
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City | SULPHUR
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State | OK
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Zip | 73086-4459
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Country | US
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Telephone | 580-622-2353
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Fax | 580-622-2351
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN OHENHEN
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Credential | MD
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Telephone | 580-622-2353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23001
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License Number State | OK
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