Provider Demographics
NPI:1073001756
Name:OKLAHOMA CLINICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:OKLAHOMA CLINICAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-513-4522
Mailing Address - Street 1:6525 N MERIDIAN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1411
Mailing Address - Country:US
Mailing Address - Phone:405-593-0583
Mailing Address - Fax:405-276-5703
Practice Address - Street 1:6525 N MERIDIAN AVE STE 110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1411
Practice Address - Country:US
Practice Address - Phone:405-593-0583
Practice Address - Fax:405-276-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty