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General NPI Number Information
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NPI Number | 1790602910
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Entity Type | Organization
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Legal Business Name | ABC SUPPORT COMPANY LLC
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 213 N BROADWAY ST
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City | CHECOTAH
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State | OK
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Zip | 74426-2431
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Country | US
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Telephone | 405-433-6665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1067
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City | CHECOTAH
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State | OK
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Zip | 74426-1067
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Country | US
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Telephone | 405-433-6665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOBY BUSCH
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Credential | OWNER
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Telephone | 405-433-6665
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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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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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