Provider Demographics
NPI:1851914113
Name:DLS MEDICAL CLINIC
Entity Type:Organization
Organization Name:DLS MEDICAL CLINIC
Other - Org Name:STIGLER PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:918-967-0055
Mailing Address - Street 1:903 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2341
Mailing Address - Country:US
Mailing Address - Phone:918-967-0055
Mailing Address - Fax:918-967-2808
Practice Address - Street 1:907 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1611
Practice Address - Country:US
Practice Address - Phone:918-967-0055
Practice Address - Fax:918-967-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK124634OtherAPRN LICENSE