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General NPI Number Information
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NPI Number | 1891823894
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Entity Type | Organization
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Legal Business Name | MAIN CLINIC PC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 216 S MAIN
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City | LINDSAY
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State | OK
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Zip | 73052
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Country | US
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Telephone | 405-756-9513
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Fax | 405-756-9517
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Provider Business Mailing Address
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Address Line | 216 S MAIN
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City | LINDSAY
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State | OK
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Zip | 73052
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Country | US
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Telephone | 405-756-9513
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Fax | 405-756-9517
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TAMMIE HEATH
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Credential |
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Telephone | 405-756-9513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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