Provider Demographics
NPI:1265755441
Name:REGAL HEALTHCARE LLC
Entity type:Organization
Organization Name:REGAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:405-341-4643
Mailing Address - Street 1:PO BOX 248875
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8875
Mailing Address - Country:US
Mailing Address - Phone:405-341-4643
Mailing Address - Fax:
Practice Address - Street 1:1101 N. BRYANT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3251
Practice Address - Country:US
Practice Address - Phone:405-341-4643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty