Provider Demographics
NPI:1003949884
Name:LAWTON URGENT CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:LAWTON URGENT CARE ASSOCIATES LLC
Other - Org Name:WELLFAST URGENT CARE CENTER WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSELHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-536-9400
Mailing Address - Street 1:20 NW 67TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5630
Mailing Address - Country:US
Mailing Address - Phone:580-536-9400
Mailing Address - Fax:580-536-9401
Practice Address - Street 1:20 NW 67TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5630
Practice Address - Country:US
Practice Address - Phone:580-536-9400
Practice Address - Fax:580-536-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK014482465261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101740AMedicaid