Provider Demographics
NPI:1457892184
Name:ROBINSON MEDICAL CLINIC EAST, LLC
Entity Type:Organization
Organization Name:ROBINSON MEDICAL CLINIC EAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-225-4000
Mailing Address - Street 1:1221 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2800
Mailing Address - Country:US
Mailing Address - Phone:580-225-4000
Mailing Address - Fax:580-243-3408
Practice Address - Street 1:1221 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2800
Practice Address - Country:US
Practice Address - Phone:580-225-4000
Practice Address - Fax:580-243-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9687207Q00000X
OK0083428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200557990Medicaid
OK200557990Medicaid
OKOK701166Medicare PIN
OK378066TQKGMedicare PIN