=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770305211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAO NEWTON ENTERPRISES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N RODEO DR
-----------------------------------------------------
City | COMANCHE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73529-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-439-5848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275825 E 1840 RD
-----------------------------------------------------
City | COMANCHE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73529-4046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-590-9462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEAH NEWTON
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 580-439-5848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------