Provider Demographics
NPI:1255512505
Name:CONVENIENCE CARE CLINICS OF MIDWEST CITY, LLC
Entity type:Organization
Organization Name:CONVENIENCE CARE CLINICS OF MIDWEST CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-4466
Mailing Address - Street 1:7199 SE 29TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-6003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7199 SE 29TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-6003
Practice Address - Country:US
Practice Address - Phone:405-418-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVENIENCE CARE CLINICS FRANCHISE COMPANY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service