Provider Demographics
NPI:1386656957
Name:ROCK CREEK CLINIC, LP
Entity Type:Organization
Organization Name:ROCK CREEK CLINIC, LP
Other - Org Name:ACCESS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-470-1500
Mailing Address - Street 1:10701 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4537
Mailing Address - Country:US
Mailing Address - Phone:405-470-1500
Mailing Address - Fax:405-603-8109
Practice Address - Street 1:10701 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4537
Practice Address - Country:US
Practice Address - Phone:405-470-1500
Practice Address - Fax:405-603-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty