Basic Information
| Provider Information | |||||||||
| NPI: | 1245280593 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WARREN CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 908 | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745020908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184260240 | ||||||||
| FaxNumber: | 9184234051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 E VAN BUREN AVE | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745014245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184260240 | ||||||||
| FaxNumber: | 9184234051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9184260240 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WARREN CLINIC MCALESTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1324230001 | OK | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.