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ST. MADRON MEDICAL CLINIC NPI 1285068791


NPI Information

NPI: 1285068791
Provider Name: ST. MADRON MEDICAL CLINIC

Former Legal Business Name: WELLNESS CLINIC OF ROLAND INC

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
205 E. RAY FINE BLVD ST. 6
ROLAND, OK
ZIP 74954
Phone: (918) 503-6235
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ST. MADRON MEDICAL CLINIC is a specialist in Roland, OK. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ST. MADRON MEDICAL CLINIC NPI is 1285068791. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Wellness Clinic Of Roland Inc.

The provider's business location address is:

205 E. RAY FINE BLVD ST. 6
ROLAND, OK
ZIP 74954
Phone: (918) 503-6235
Fax: (918) 398-0637

The provider's authorized official is Darren Brewer .
The authorized official title is Owner and has the following contact phone number (918) 503-6235.

The enumeration date for this NPI number is 9/3/2013 and was last updated on 8/6/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist17754OKLAHOMAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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