Provider Demographics
NPI:1811366032
Name:SDO GROUP LLC
Entity Type:Organization
Organization Name:SDO GROUP LLC
Other - Org Name:SKIATOOK FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUBERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-396-1262
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1211
Mailing Address - Country:US
Mailing Address - Phone:918-396-1262
Mailing Address - Fax:918-396-4598
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1211
Practice Address - Country:US
Practice Address - Phone:918-396-1262
Practice Address - Fax:918-396-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3385207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty