NPIMap

Organization Active NPI

Team Clinics Ah LLC

  • Primary Care Clinic/Center
  • Broken Arrow, OK
National Provider Identifier
1114559705
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
TEAM CLINICS AH LLC
Practice address
1600 W Quincy St # 100a
Broken Arrow, OK 74012-5219
Phone
(405) 546-4130
NPI assigned
Feb 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Authorized official

Name
Trevor Nutt
Title
Ceo
Phone
(405) 546-4130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1600 W Quincy St # 100a
Broken Arrow, OK 74012-5219

Mailing address

3112 Cooke Way
Oklahoma City, OK 73179-2401
Phone (405) 600-6869

Other identifiers 1

IdentifierTypeStateIssuer
200782030MedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Team Clinics Ah LLC41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

1600 W Quincy St
#100A
Broken Arrow, OK 74012

NPI Registry JSON

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

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1114559705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 COOKE WAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731792401",
            "telephone_number": "405-600-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W QUINCY ST # 100A",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125219",
            "telephone_number": "405-546-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAM CLINICS AH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-11",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "NUTT",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-546-4130"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200782030",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.