| Team Clinics Ah Llc | |
|
3500 E Kenosha St Broken Arrow OK 74014-6758 | |
| (405) 546-4130 | |
| Not Available |
| Full Name | Team Clinics Ah Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3500 E Kenosha St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Trevor Nutt (CEO) |
| Authorized Official Contact | 4055464130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: (405) 546-4130 | Team Clinics Ah Llc 3500 E Kenosha St Broken Arrow OK 74014-6758 Ph: (405) 546-4130 |
| NPI Number | 1871110775 |
|---|---|
| Provider Enumeration Date | 06/26/2020 |
| Last Update Date | 06/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871110775 | NPI | - | NPPES |
| 200782030 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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