Provider Demographics
NPI:1992861983
Name:WARREN CLINIC JENKS
Entity Type:Organization
Organization Name:WARREN CLINIC JENKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-298-2336
Mailing Address - Street 1:2605 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3429
Mailing Address - Country:US
Mailing Address - Phone:918-298-2336
Mailing Address - Fax:918-298-2337
Practice Address - Street 1:2605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3429
Practice Address - Country:US
Practice Address - Phone:918-298-2336
Practice Address - Fax:918-298-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19667261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKAR2602301OtherDEA
OKD42767Medicare UPIN