Provider Demographics
NPI:1902044480
Name:NORTHEAST OKLAHOMA CLINICAL PARTNERS, INC.
Entity Type:Organization
Organization Name:NORTHEAST OKLAHOMA CLINICAL PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:WALK
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:918-256-7551
Mailing Address - Street 1:PO BOX 3096
Mailing Address - Street 2:DEPT 525
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-3096
Mailing Address - Country:US
Mailing Address - Phone:918-256-0252
Mailing Address - Fax:
Practice Address - Street 1:735 N FOREMAN ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1422
Practice Address - Country:US
Practice Address - Phone:918-256-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2182261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center