Provider Demographics
NPI:1558563189
Name:PARTNERS IN HEALTH MULTICARE CLINIC
Entity type:Organization
Organization Name:PARTNERS IN HEALTH MULTICARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFOON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-973-4306
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-0309
Mailing Address - Country:US
Mailing Address - Phone:405-973-4306
Mailing Address - Fax:
Practice Address - Street 1:5100 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8581
Practice Address - Country:US
Practice Address - Phone:405-973-4306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062152363LF0000X
OKR0054748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1073594032OtherNPI
OK1942236690OtherNPI