Provider Demographics
NPI:1760485767
Name:MINOR EMERGENCY CLINIC
Entity Type:Organization
Organization Name:MINOR EMERGENCY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATZKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-234-1831
Mailing Address - Street 1:402 S OAKWOOD RD
Mailing Address - Street 2:STE B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4945
Mailing Address - Country:US
Mailing Address - Phone:580-234-1831
Mailing Address - Fax:580-234-1834
Practice Address - Street 1:402 S OAKWOOD RD
Practice Address - Street 2:STE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4945
Practice Address - Country:US
Practice Address - Phone:580-234-1831
Practice Address - Fax:580-234-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare ID - Type Unspecified