Provider Demographics
NPI:1245353713
Name:TRICITIES MEDICAL & SURGICAL
Entity type:Organization
Organization Name:TRICITIES MEDICAL & SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MADRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-257-6272
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-1221
Mailing Address - Country:US
Mailing Address - Phone:405-257-6272
Mailing Address - Fax:405-257-6273
Practice Address - Street 1:1509 S INDIAN RD
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-9781
Practice Address - Country:US
Practice Address - Phone:405-257-6272
Practice Address - Fax:405-257-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100737390AMedicaid
OK200037050AMedicaid
OK1902885817OtherNPI FOR TRUDI FREELAND
OK200007490AMedicaid
OK200007490AMedicaid
OK100737390AMedicaid