Provider Demographics
NPI:1851781975
Name:URGENT CARE WALK IN CLINIC LLC
Entity Type:Organization
Organization Name:URGENT CARE WALK IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM CMPCS CHM
Authorized Official - Phone:580-924-4707
Mailing Address - Street 1:702 BRYAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7030
Mailing Address - Country:US
Mailing Address - Phone:580-924-4707
Mailing Address - Fax:580-924-6001
Practice Address - Street 1:702 BRYAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7030
Practice Address - Country:US
Practice Address - Phone:580-924-4707
Practice Address - Fax:580-924-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care