Provider Demographics
NPI:1033759519
Name:ARABELLA MEDICAL SPA LLC
Entity Type:Organization
Organization Name:ARABELLA MEDICAL SPA LLC
Other - Org Name:ARABELLA MEDICAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-210-9864
Mailing Address - Street 1:701 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6778
Mailing Address - Country:US
Mailing Address - Phone:405-265-2111
Mailing Address - Fax:
Practice Address - Street 1:701 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6778
Practice Address - Country:US
Practice Address - Phone:405-265-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty