MEDICARE: ROBINSON MEDICAL CLINIC EAST, LLC

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
1	363LF0000X	Family Nurse Practitioner	0083428	OK
2	207Q00000X	Family Medicine Physician	9687	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457892184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBINSON MEDICAL CLINIC EAST, LLC

Provider Business Mailing Address
First Line	:	1221 COLORADO AVE
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-2800
Country	:	US
Telephone Number	:	580-225-4000
Fax Number	:	580-243-3408

Provider Business Practice Location Address
First Line	:	1221 COLORADO AVE
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-2800
Country	:	US
Telephone Number	:	580-225-4000
Fax Number	:	580-243-3408

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LINDSAY KAY ROBINSON
Credential	:
Telephone Number	:	580-225-4000

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	03/29/2023

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