Provider Demographics
NPI:1336553502
Name:MEDRITE LLC
Entity Type:Organization
Organization Name:MEDRITE LLC
Other - Org Name:MEDRITE OKMULGEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-779-0709
Mailing Address - Street 1:109 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5015
Mailing Address - Country:US
Mailing Address - Phone:918-779-0709
Mailing Address - Fax:918-392-4552
Practice Address - Street 1:7307 S YALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7028
Practice Address - Country:US
Practice Address - Phone:918-710-2062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care