Provider Demographics
NPI:1770927790
Name:PREVENT CLINIC LLC
Entity type:Organization
Organization Name:PREVENT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURGAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-239-6862
Mailing Address - Street 1:2410 W MEMORIAL RD
Mailing Address - Street 2:STE C #156
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8047
Mailing Address - Country:US
Mailing Address - Phone:806-239-6862
Mailing Address - Fax:806-209-0000
Practice Address - Street 1:4500 N CLASSEN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4834
Practice Address - Country:US
Practice Address - Phone:405-601-8102
Practice Address - Fax:806-209-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty