Provider Demographics
NPI:1881187805
Name:LONG JACKET PLLC
Entity Type:Organization
Organization Name:LONG JACKET PLLC
Other - Org Name:ERIN SLOAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-243-9122
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1408
Mailing Address - Country:US
Mailing Address - Phone:580-243-9122
Mailing Address - Fax:580-225-5423
Practice Address - Street 1:1710 W 3RD ST STE 102
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5160
Practice Address - Country:US
Practice Address - Phone:580-243-9122
Practice Address - Fax:580-225-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty