Provider Demographics
NPI:1003139155
Name:RINGROSE CLINIC, INC.
Entity Type:Organization
Organization Name:RINGROSE CLINIC, INC.
Other - Org Name:RINGROSE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RINGROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-282-0232
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-0010
Mailing Address - Country:US
Mailing Address - Phone:405-282-0232
Mailing Address - Fax:405-282-7109
Practice Address - Street 1:324 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3315
Practice Address - Country:US
Practice Address - Phone:405-282-0232
Practice Address - Fax:405-282-7109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RINGROSE CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-03
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732020AMedicaid
C95415Medicare UPIN
OK100732020AMedicaid