Provider Demographics
NPI:1083153514
Name:ALLEN HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:ALLEN HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PRENTICE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:580-857-2424
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-0350
Mailing Address - Country:US
Mailing Address - Phone:580-857-2424
Mailing Address - Fax:580-857-2220
Practice Address - Street 1:202 W BROADWAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74824
Practice Address - Country:US
Practice Address - Phone:580-857-2424
Practice Address - Fax:580-857-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86291261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care