Provider Demographics
NPI:1346012978
Name:OKLAHOMA INDUSTRIAL MEDICINE LLC
Entity Type:Organization
Organization Name:OKLAHOMA INDUSTRIAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-725-3055
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-1065
Mailing Address - Country:US
Mailing Address - Phone:479-725-3000
Mailing Address - Fax:
Practice Address - Street 1:4330 SE 29TH ST STE 3018
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3335
Practice Address - Country:US
Practice Address - Phone:405-670-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty