Provider Demographics
NPI:1124329602
Name:EL RENO COMMUNITY CLINIC, INC. DBA 'PHCC'
Entity type:Organization
Organization Name:EL RENO COMMUNITY CLINIC, INC. DBA 'PHCC'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LINAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:405-249-6064
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-0427
Mailing Address - Country:US
Mailing Address - Phone:405-213-4899
Mailing Address - Fax:405-373-3707
Practice Address - Street 1:100 S ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2733
Practice Address - Country:US
Practice Address - Phone:405-213-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B0000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management