Provider Demographics
NPI:1487012100
Name:ROSS ENTERPRISES INC
Entity Type:Organization
Organization Name:ROSS ENTERPRISES INC
Other - Org Name:PRIMARYCARE OF ADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-436-4400
Mailing Address - Street 1:1023 ARLINGTON ST
Mailing Address - Street 2:STE B
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1023 ARLINGTON ST
Practice Address - Street 2:STE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4042
Practice Address - Country:US
Practice Address - Phone:580-279-6313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty