Provider Demographics
NPI:1134314388
Name:FIRSTCARE MEDICAL CLINIC OF MUSKOGEE PLLC
Entity Type:Organization
Organization Name:FIRSTCARE MEDICAL CLINIC OF MUSKOGEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-683-8100
Mailing Address - Street 1:3300 CHANDLER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4957
Mailing Address - Country:US
Mailing Address - Phone:918-681-3333
Mailing Address - Fax:918-681-3336
Practice Address - Street 1:3300 CHANDLER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4957
Practice Address - Country:US
Practice Address - Phone:918-681-3333
Practice Address - Fax:918-681-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
446187037001OtherBCBS OF OKLAHOMA
P00011976OtherRAILROAD MEDICARE
446187037MMedicare PIN
D35211Medicare UPIN