NPIMap

Organization Active NPI

Eagle Community Clinic LLC

  • Family Medicine Physician
  • Edmond, OK
National Provider Identifier
1063790202
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAGLE COMMUNITY CLINIC LLC
Practice address
13800 Benson Rd
202
Edmond, OK 73013-6422
Phone
(405) 418-3077
Fax
(405) 418-3076
NPI assigned
Jul 21, 2011
Organization subpart
Yes
Parent organization
OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandon L Penick
Title
Director of Reimbursement
Phone
(405) 360-6764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

13800 Benson Rd
202
Edmond, OK 73013-6422

Mailing address

PO Box 5995
Norman, OK 73070-5995
Phone (405) 360-6764

National Provider Directory

National Provider Directory
Part of
Oklahoma Sports and Orthopedics Institute PLLC

Locations

13800 Benson Rd
#202
Edmond, OK 73013
Phone (405) 418-3077

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1063790202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5995",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730705995",
            "telephone_number": "405-360-6764",
            "fax_number": "405-360-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 BENSON RD",
            "address_2": "202",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730136422",
            "telephone_number": "405-418-3077",
            "fax_number": "405-418-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE COMMUNITY CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "PENICK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "405-360-6764"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.