Provider Demographics
NPI:1740533538
Name:MCKOWN CLINIC PLLC
Entity type:Organization
Organization Name:MCKOWN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-226-7181
Mailing Address - Street 1:PO BOX 2371
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-2371
Mailing Address - Country:US
Mailing Address - Phone:580-226-7181
Mailing Address - Fax:580-226-7192
Practice Address - Street 1:1001 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1803
Practice Address - Country:US
Practice Address - Phone:580-226-7181
Practice Address - Fax:580-226-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center