Provider Demographics
NPI:1669898607
Name:LTC SOLUTIONS, PLLC
Entity type:Organization
Organization Name:LTC SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-520-0859
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435-0479
Mailing Address - Country:US
Mailing Address - Phone:918-520-0859
Mailing Address - Fax:918-489-5260
Practice Address - Street 1:604 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:GORE
Practice Address - State:OK
Practice Address - Zip Code:74435-0479
Practice Address - Country:US
Practice Address - Phone:918-520-0859
Practice Address - Fax:918-489-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK353194ZG6KMedicare PIN
OK100257880CMedicaid