Provider Demographics
NPI:1417253022
Name:ALLCARE PLLC
Entity Type:Organization
Organization Name:ALLCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLACKSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-216-4006
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-1109
Mailing Address - Country:US
Mailing Address - Phone:918-216-4006
Mailing Address - Fax:918-216-4007
Practice Address - Street 1:730 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5766
Practice Address - Country:US
Practice Address - Phone:918-216-4006
Practice Address - Fax:918-216-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3650207Q00000X
OK1327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty