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NPI Code Detail

MEDICARE: CITY RESCUE MISSION MEDICAL CLINIC

MEDICARE: CITY RESCUE MISSION MEDICAL CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center

General Provider Information

NPI Number : 1194944272
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY RESCUE MISSION MEDICAL CLINIC
Provider Business Mailing Address
First Line : 800 W CALIFORNIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7807
Country : US
Telephone Number : 405-232-2709
Fax Number : 405-236-0341
Provider Business Practice Location Address
First Line : 800 W CALIFORNIA AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7807
Country : US
Telephone Number : 405-232-2709
Fax Number : 405-236-0341
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : DEBRA MCCULLOCK
Credential : ARNP
Telephone Number : 405-232-2709
Provider Enumeration Date : 04/25/2007
Last Update Date : 08/22/2020

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Directions to “CITY RESCUE MISSION MEDICAL CLINIC ” Practice Location

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