Basic Information
| Provider Information | |||||||||
| NPI: | 1427337518 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLASSEN URGENT CARE CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2818 CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058189600 | ||||||||
| FaxNumber: | 4053645379 | ||||||||
| Practice Location | |||||||||
| Address1: | 2818 CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057017111 | ||||||||
| FaxNumber: | 4057017165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | TORBATI | ||||||||
| AuthorizedOfficialFirstName: | HUSSEIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4058189600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 200357090A | 05 | OK | MEDICAID | 6942150001 | 01 | OK | DMEPOS | OTHER |