Provider Demographics
NPI:1942691175
Name:RHEUMATIC DISEASES CLINIC OF OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:RHEUMATIC DISEASES CLINIC OF OKLAHOMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:EDLIN
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-606-8070
Mailing Address - Street 1:PO BOX 2237
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-2237
Mailing Address - Country:US
Mailing Address - Phone:405-606-8070
Mailing Address - Fax:405-606-6350
Practice Address - Street 1:1111 N LEE AVE
Practice Address - Street 2:SUITE 249
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2600
Practice Address - Country:US
Practice Address - Phone:405-606-8070
Practice Address - Fax:405-606-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty