Amattco LLC
Organization Active NPI Specialist · Broken Arrow, OK
NPI 1477009256 · NPPES record last updated Aug 31, 2016
Key facts
- NPI
- 1477009256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 73548 (OK)
- Legal business name
- AMATTCO LLC
- Practice address
- 3100 S Elm PL
Suite B
Broken Arrow, OK 74012-7950 - Phone
- (918) 884-7800
- Fax
- (918) 731-4518
- NPI assigned
- Aug 31, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- AMATTCO LLC
Authorized official
- Name
- Dr. David Ryker Sr., MD
- Title
- Supervising Physican
- Phone
- (405) 751-9800
National Provider Directory
- Part of
- Amattco LLC
Locations
3705 W Memorial Rd
Ste 601
Oklahoma City, OK 73134
Phone (405) 749-0900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 9365 | OK | |
| Specialist |
174400000X | 73548 | OK | Yes |
| Nurse Practitioner |
363L00000X | 79139 | OK | |
| Nurse Practitioner |
363L00000X | R0078723 | OK | |
| Nurse Practitioner |
363L00000X | 86262 | OK |
Addresses
Primary practice location
3100 S Elm PL
Suite B
Broken Arrow, OK 74012-7950
Mailing address
3705 West Memorial Rd
Suite 601
Oklahoma City, OK 73134-1512
Phone (405) 751-9800
Other names
- New Leaf Wellness Center
Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.