Basic Information
| Provider Information | |||||||||
| NPI: | 1720589351 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLASSEN URGENT CARE CLINIC LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLASSEN URGENT CARE - MOORE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2818 CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730714059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057017111 | ||||||||
| FaxNumber: | 4057017165 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 SW 4TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731602404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057017111 | ||||||||
| FaxNumber: | 4054457660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TORBATI | ||||||||
| AuthorizedOfficialFirstName: | HUSSEIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4057017111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLASSEN URGENT CARE CLINIC LLC | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 261QU0200X | OK | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.