Provider Demographics
NPI:1083850010
Name:COSMOCOMET.LLC
Entity Type:Organization
Organization Name:COSMOCOMET.LLC
Other - Org Name:DR. ROBIN WESTERN D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HABECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-342-2528
Mailing Address - Street 1:1222 N FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3147
Mailing Address - Country:US
Mailing Address - Phone:918-342-2528
Mailing Address - Fax:918-342-2538
Practice Address - Street 1:1222 N FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3147
Practice Address - Country:US
Practice Address - Phone:918-342-2528
Practice Address - Fax:918-342-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3245261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1538151246OtherINDIVIDUAL NPI