Provider Demographics
NPI:1841569217
Name:EXPRESSWAY CLINIC, LLC
Entity Type:Organization
Organization Name:EXPRESSWAY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-556-5102
Mailing Address - Street 1:8105 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6004
Mailing Address - Country:US
Mailing Address - Phone:405-602-3500
Mailing Address - Fax:405-602-3550
Practice Address - Street 1:8105 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6004
Practice Address - Country:US
Practice Address - Phone:405-602-3500
Practice Address - Fax:405-602-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty