Provider Demographics
NPI:1932470234
Name:JAMES P. WORRELL M.D., P.C.
Entity Type:Organization
Organization Name:JAMES P. WORRELL M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-234-3788
Mailing Address - Street 1:3201 N VAN BUREN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1812
Mailing Address - Country:US
Mailing Address - Phone:580-234-3788
Mailing Address - Fax:580-234-3372
Practice Address - Street 1:3201 N VAN BUREN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1812
Practice Address - Country:US
Practice Address - Phone:580-234-3788
Practice Address - Fax:580-234-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK562173375Medicare PIN
OKF12115Medicare UPIN