Provider Demographics
NPI:1891823894
Name:MAIN CLINIC PC
Entity Type:Organization
Organization Name:MAIN CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-756-9513
Mailing Address - Street 1:216 S MAIN
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052
Mailing Address - Country:US
Mailing Address - Phone:405-756-9513
Mailing Address - Fax:405-756-9517
Practice Address - Street 1:216 S MAIN
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-9513
Practice Address - Fax:405-756-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty