Provider Demographics
NPI:1346441896
Name:CHOCTAW WELLNESS ENTERPRISES, LLC
Entity Type:Organization
Organization Name:CHOCTAW WELLNESS ENTERPRISES, LLC
Other - Org Name:CHOCTAW AFTER-HOURS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-390-9600
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0010
Mailing Address - Country:US
Mailing Address - Phone:405-390-9600
Mailing Address - Fax:405-390-9400
Practice Address - Street 1:15803 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8428
Practice Address - Country:US
Practice Address - Phone:405-390-9600
Practice Address - Fax:405-390-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty