| Team Clinics Ah Llc | |
|
1600 W Quincy St # 100a Broken Arrow OK 74012-5219 | |
| (405) 546-4130 | |
| Not Available |
| Full Name | Team Clinics Ah Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1600 W Quincy St # 100a, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Trevor Nutt (CEO) |
| Authorized Official Contact | 4055464130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: (405) 600-6869 | Team Clinics Ah Llc 1600 W Quincy St # 100a Broken Arrow OK 74012-5219 Ph: (405) 546-4130 |
| NPI Number | 1114559705 |
|---|---|
| Provider Enumeration Date | 02/11/2020 |
| Last Update Date | 06/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114559705 | NPI | - | NPPES |
| 200782030 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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