Provider Demographics
NPI:1760494884
Name:OCA II EDMOND, LLC
Entity Type:Organization
Organization Name:OCA II EDMOND, LLC
Other - Org Name:ACCESS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-844-5210
Mailing Address - Street 1:46 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4301
Mailing Address - Country:US
Mailing Address - Phone:405-844-5210
Mailing Address - Fax:405-341-7074
Practice Address - Street 1:46 E 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4301
Practice Address - Country:US
Practice Address - Phone:405-844-5210
Practice Address - Fax:405-341-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty