Sallisaw Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4825 Issued in OK

Legal business name

SALLISAW MEDICAL CLINIC LLC

Practice address

202 E Cherokee Ave
Sallisaw, OK 74955-4600

Phone

(918) 790-2890

Fax

(918) 790-2906

NPI assigned

Feb 6, 2012

Organization subpart

No

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

Authorized official

Name

Amelia L PoitevintNPI 1427357243

Title

Owner

Phone

(918) 790-2890

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amelia Leigh Poitevint

  • Contractor
  • Sallisaw, OK
  • NPI 1427357243
  NPD Authorized official

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1306118377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554600",
            "telephone_number": "918-790-2890",
            "fax_number": "918-790-2906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554600",
            "telephone_number": "918-790-2890",
            "fax_number": "918-790-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALLISAW MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "POITEVINT",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-790-2890"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4840",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4825",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0074165",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie R Rowell
• Natalie Elise Russell, R.D.
• Sallisaw Chiropractic Clinic
• Sallisaw Chiropractic Clinic Inc.
• Sallisaw Family Medicine, L.L.C.
• Sallisaw Mental Health LLC
• Sallisaw Pharmacy Inc
• Sallisaw Pharmacy Inc
• Sallisaw Public School
• Sallisaw State Veterans Home

• All providers in Sallisaw, OK
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; 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.