Provider Demographics
NPI:1609460716
Name:PEACE JOY CLINIC PLLC
Entity Type:Organization
Organization Name:PEACE JOY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINH
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-928-5597
Mailing Address - Street 1:8214 E 111TH PL S UNIT 100
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2452
Mailing Address - Country:US
Mailing Address - Phone:918-928-5597
Mailing Address - Fax:
Practice Address - Street 1:8214 E 111TH PL S UNIT 100
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2452
Practice Address - Country:US
Practice Address - Phone:918-928-5597
Practice Address - Fax:918-228-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care