Provider Demographics
NPI:1457558827
Name:DOCTORS CLINIC OF DURANT INC
Entity Type:Organization
Organization Name:DOCTORS CLINIC OF DURANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-1700
Mailing Address - Street 1:1400 BRYAN DR
Mailing Address - Street 2:#300
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2158
Mailing Address - Country:US
Mailing Address - Phone:580-924-1700
Mailing Address - Fax:580-924-1736
Practice Address - Street 1:1400 BRYAN DR
Practice Address - Street 2:#300
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2158
Practice Address - Country:US
Practice Address - Phone:580-924-1700
Practice Address - Fax:580-924-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100733950CMedicaid
OK373828Medicare ID - Type Unspecified
OK373828Medicare Oscar/Certification