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General NPI Number Information
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NPI Number | 1568279321
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Entity Type | Organization
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Legal Business Name | NORTHERN OKLAHOMA URGENT CARE
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 16603 W SOUTH AVE
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City | TONKAWA
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State | OK
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Zip | 74653-0008
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Country | US
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Telephone | 580-761-0041
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | TONKAWA
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State | OK
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Zip | 74653-0008
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Country | US
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Telephone | 580-761-0041
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHARLES JANTZEN
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Credential | DO
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Telephone | 580-231-4196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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