Provider Demographics
NPI:1629254651
Name:ANGESL HEALTH CARE CLINIC
Entity Type:Organization
Organization Name:ANGESL HEALTH CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLOWERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-287-2100
Mailing Address - Street 1:230 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5204
Mailing Address - Country:US
Mailing Address - Phone:918-287-2100
Mailing Address - Fax:918-287-2113
Practice Address - Street 1:230 E 5TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5204
Practice Address - Country:US
Practice Address - Phone:918-287-2100
Practice Address - Fax:918-287-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain