| Team Clinics Ah Llc | |
|
3112 Cooke Way Oklahoma City OK 73179-2401 | |
| (405) 600-6869 | |
| Not Available |
| Full Name | Team Clinics Ah Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3112 Cooke Way, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Trevor Nutt (CEO) |
| Authorized Official Contact | 4055464130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: () - | Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: (405) 600-6869 |
| NPI Number | 1821506528 |
|---|---|
| Provider Enumeration Date | 01/16/2018 |
| Last Update Date | 06/28/2021 |
| Medicare PECOS PAC ID | 4688903248 |
|---|---|
| Medicare Enrollment ID | O20190906000826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821506528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Kevin M Penwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841286333 PECOS PAC ID: 8325005580 Enrollment ID: I20041220000487 |
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