Provider Demographics
NPI:1700189065
Name:WYNNEWOOD MEDICAL CLINICS
Entity Type:Organization
Organization Name:WYNNEWOOD MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:405-665-4351
Mailing Address - Street 1:116 E ROBERT S KERR BLVD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-6621
Mailing Address - Country:US
Mailing Address - Phone:405-665-4351
Mailing Address - Fax:
Practice Address - Street 1:116 E ROBERT S KERR BLVD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-6621
Practice Address - Country:US
Practice Address - Phone:405-665-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARBUCKLE INTERNAL MEDICINE GROUP,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-08
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty