Provider Demographics
NPI:1558816850
Name:SPECTRUM HEALTHCARE SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:SPECTRUM HEALTHCARE SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-768-5749
Mailing Address - Street 1:PO BOX 6276
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-6276
Mailing Address - Country:US
Mailing Address - Phone:405-768-5749
Mailing Address - Fax:405-493-8506
Practice Address - Street 1:1145 W I 240 SERVICE RD STE F100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-769-5749
Practice Address - Fax:405-493-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26716207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK193200000XOtherTAXONOMY CODE