Provider Demographics
NPI:1922055136
Name:KRABLIN MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:KRABLIN MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KRABLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-657-8816
Mailing Address - Street 1:PO BOX 32348
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0331
Mailing Address - Country:US
Mailing Address - Phone:888-337-2521
Mailing Address - Fax:405-261-0335
Practice Address - Street 1:301 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OK
Practice Address - Zip Code:73051-8960
Practice Address - Country:US
Practice Address - Phone:405-590-4478
Practice Address - Fax:405-696-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK611206400OtherDEPT OF LABOR
OK100756040AMedicaid
OK100756040AMedicaid
DB2453Medicare PIN
OK700522102Medicare ID - Type Unspecified