Basic Information
| Provider Information | |||||||||
| NPI: | 1609372036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPIRICARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13924 QUAIL POINTE DR STE B | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058967901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3130 SW 89TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059239042 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | BOWLWARE | ||||||||
| AuthorizedOfficialFirstName: | KEN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4059239042 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3557 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.