Provider Demographics
NPI:1124178637
Name:RODGER C. MATTSON, D.O., P.C.
Entity Type:Organization
Organization Name:RODGER C. MATTSON, D.O., P.C.
Other - Org Name:CHELSEA FAMILY MEDICAL CLINID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-789-3146
Mailing Address - Street 1:403 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1453
Mailing Address - Country:US
Mailing Address - Phone:918-789-3146
Mailing Address - Fax:918-789-5650
Practice Address - Street 1:403 REDBUD LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1453
Practice Address - Country:US
Practice Address - Phone:918-789-3146
Practice Address - Fax:918-789-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2000014530CMedicaid
OK200522045Medicare ID - Type Unspecified
OK2000014530CMedicaid