Provider Demographics
NPI:1407367717
Name:LYNDA K ENKOFF HEALTH BLOOMS
Entity Type:Organization
Organization Name:LYNDA K ENKOFF HEALTH BLOOMS
Other - Org Name:HEALTH BLOOMS WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ENKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-208-8937
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1154
Mailing Address - Country:US
Mailing Address - Phone:918-208-8937
Mailing Address - Fax:918-208-7687
Practice Address - Street 1:500 S BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3818
Practice Address - Country:US
Practice Address - Phone:918-208-7497
Practice Address - Fax:918-208-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty