Provider Demographics
NPI:1407932981
Name:URGENT MEDCARE CLINIC
Entity Type:Organization
Organization Name:URGENT MEDCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:405-381-9979
Mailing Address - Street 1:4805 E HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8791
Mailing Address - Country:US
Mailing Address - Phone:405-381-9979
Mailing Address - Fax:405-381-9130
Practice Address - Street 1:4805 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8791
Practice Address - Country:US
Practice Address - Phone:405-381-9979
Practice Address - Fax:405-381-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054600BMedicaid
OK200054600AMedicaid
OK200054600CMedicaid
OK200054600CMedicaid
OK200054600BMedicaid
OK=========001OtherBLUE CROSS & BLUE SHIELD