Provider Demographics
NPI:1770382699
Name:PM MEDICAL LLC
Entity type:Organization
Organization Name:PM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-413-8542
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:MCCURTAIN
Mailing Address - State:OK
Mailing Address - Zip Code:74944-0161
Mailing Address - Country:US
Mailing Address - Phone:918-413-8542
Mailing Address - Fax:
Practice Address - Street 1:801 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2304
Practice Address - Country:US
Practice Address - Phone:918-413-8542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty