Provider Demographics
NPI:1912209446
Name:TRITON EMERGENCY MEDICINE
Entity Type:Organization
Organization Name:TRITON EMERGENCY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:NATHANIAL
Authorized Official - Last Name:CLAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-520-6854
Mailing Address - Street 1:3316 ELMO WAY
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2380
Mailing Address - Country:US
Mailing Address - Phone:918-520-6854
Mailing Address - Fax:
Practice Address - Street 1:3316 ELMO WAY
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2380
Practice Address - Country:US
Practice Address - Phone:918-520-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty