Provider Demographics
NPI:1205273414
Name:PAULS VALLEY URGENT CARE LLC
Entity type:Organization
Organization Name:PAULS VALLEY URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-519-7674
Mailing Address - Street 1:2000 W GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-9233
Mailing Address - Country:US
Mailing Address - Phone:918-519-7674
Mailing Address - Fax:
Practice Address - Street 1:2000 W GRANT AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-9233
Practice Address - Country:US
Practice Address - Phone:918-519-7674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108330AMedicaid
OK301333Medicare PIN