Provider Demographics
NPI:1285644153
Name:AMC URGENT CARE PLUS, LLC
Entity Type:Organization
Organization Name:AMC URGENT CARE PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-762-2366
Mailing Address - Street 1:2101 N 14TH ST
Mailing Address - Street 2:STE 114
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1807
Mailing Address - Country:US
Mailing Address - Phone:580-762-1552
Mailing Address - Fax:
Practice Address - Street 1:2101 N 14TH ST
Practice Address - Street 2:STE 114
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1807
Practice Address - Country:US
Practice Address - Phone:580-762-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty