Northeast Oklahoma Wellness Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTHEAST OKLAHOMA WELLNESS CLINIC LLC

Practice address

1500 E Downing St
Tahlequah, OK 74464-3234

Phone

(918) 456-2594

Fax

(918) 456-3395

NPI assigned

Mar 14, 2016

Last updated

Mar 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keven Partin

Title

Owner

Phone

(918) 893-6201

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1568823938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6312 E 101ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377007",
            "telephone_number": "918-893-6201",
            "fax_number": "918-893-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643234",
            "telephone_number": "918-456-2594",
            "fax_number": "918-456-3395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OKLAHOMA WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-14",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "PARTIN",
        "authorized_official_first_name": "KEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-893-6201"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.