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General NPI Number Information
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NPI Number | 1699262576
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Entity Type | Organization
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Legal Business Name | IMMEDIATE CARE OF OKLAHOMA, LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 4500 TINKER RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73135-4614
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Country | US
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Telephone | 405-600-6869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720790
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City | NORMAN
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State | OK
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Zip | 73070-4614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COM
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Name | KEVIN PENWELL
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Credential | DO
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Telephone | 405-600-6869
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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 | OK
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