Provider Demographics
NPI:1225279987
Name:ENID LUNG & KIDNEY CLINIC PLLC
Entity Type:Organization
Organization Name:ENID LUNG & KIDNEY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHU
Authorized Official - Middle Name:D
Authorized Official - Last Name:VIJAYVARGIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-0595
Mailing Address - Street 1:PO BOX 3885
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3885
Mailing Address - Country:US
Mailing Address - Phone:580-233-0595
Mailing Address - Fax:580-234-1968
Practice Address - Street 1:312 E OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5712
Practice Address - Country:US
Practice Address - Phone:580-233-0595
Practice Address - Fax:580-234-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty