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NPI Code Detail

MEDICARE: SHEPHERD'S PLACE CLINIC LLC

MEDICARE: SHEPHERD'S PLACE CLINIC 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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1699012757
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEPHERD'S PLACE CLINIC LLC
Provider Business Mailing Address
First Line : 2316 NW 23RD ST
Second Line : ST. B
City : OKLAHOMA CITY
State : OK
Zip : 73107-2406
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2316 NW 23RD ST
Second Line : ST. B
City : OKLAHOMA CITY
State : OK
Zip : 73107-2406
Country : US
Telephone Number : 405-525-3330
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. MEBIN THOMAS
Credential : PA-C
Telephone Number : 405-414-9139
Provider Enumeration Date : 01/09/2013
Last Update Date : 02/19/2013

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Directions to “SHEPHERD'S PLACE CLINIC LLC ” Practice Location

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