Provider Demographics
NPI:1518399104
Name:WYNNEWOOD URGENT CARE AND IMMEDIATE CARE CENTER PC
Entity Type:Organization
Organization Name:WYNNEWOOD URGENT CARE AND IMMEDIATE CARE CENTER PC
Other - Org Name:WYNNEWOOD URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OHENHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-665-1010
Mailing Address - Street 1:106 N.POWELL
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-0698
Mailing Address - Country:US
Mailing Address - Phone:405-665-1010
Mailing Address - Fax:405-665-1001
Practice Address - Street 1:106 N.POWELL
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-0698
Practice Address - Country:US
Practice Address - Phone:405-665-1010
Practice Address - Fax:405-665-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care