Provider Demographics
NPI:1437660446
Name:THE EDEN CLINIC, INC.
Entity Type:Organization
Organization Name:THE EDEN CLINIC, INC.
Other - Org Name:OBRIA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COZADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-579-4673
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0669
Mailing Address - Country:US
Mailing Address - Phone:405-579-4673
Mailing Address - Fax:405-579-4413
Practice Address - Street 1:1807 W LINDSEY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4101
Practice Address - Country:US
Practice Address - Phone:405-579-4773
Practice Address - Fax:405-579-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261Q00000X, 261QF0050X, 261QH0100X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health