Provider Demographics
NPI:1740921014
Name:SHARROCK MEDICAL LLC
Entity type:Organization
Organization Name:SHARROCK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SHARROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-245-7044
Mailing Address - Street 1:1401 S LYNN LN
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-6859
Mailing Address - Country:US
Mailing Address - Phone:870-279-3300
Mailing Address - Fax:
Practice Address - Street 1:1401 S LYNN LN
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6859
Practice Address - Country:US
Practice Address - Phone:870-279-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty