Provider Demographics
NPI:1114952025
Name:ESEC LLC
Entity Type:Organization
Organization Name:ESEC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARVIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-463-3484
Mailing Address - Street 1:PO BOX 268867
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8867
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-848-2425
Practice Address - Street 1:3705 NW 63RD ST
Practice Address - Street 2:STE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1905
Practice Address - Country:US
Practice Address - Phone:405-463-3484
Practice Address - Fax:405-608-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0079261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200089950AMedicaid
OKP00317452OtherMEDICARE RAILROAD
OK7703855OtherAETNA
OK5587450001Medicare NSC
OK200089950AMedicaid