Provider Demographics
NPI:1982309894
Name:THE UPDIKE CLINIC
Entity Type:Organization
Organization Name:THE UPDIKE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:UPDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-733-1351
Mailing Address - Street 1:15495 N 247 RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-7969
Mailing Address - Country:US
Mailing Address - Phone:918-733-1351
Mailing Address - Fax:918-733-1353
Practice Address - Street 1:15495 N 247 RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-7969
Practice Address - Country:US
Practice Address - Phone:918-733-1351
Practice Address - Fax:918-733-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty