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Organization
OKLAHOMA MEDICAL CLINIC LLC
Active
Organization
OKLAHOMA MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY ELLIS (MEMBER)
(405) 664-7622
Entity
Organization
Contact information
Practice address
10317 GREENBRIAR PKWY, OKLAHOMA CITY, OK 73159-7648
(405) 378-3400
(186) 632-3795
Mailing address
10317 GREENBRIAR PKWY, OKLAHOMA CITY, OK 73159-7648
(405) 378-3400
(866) 323-7959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/13/2014
Last updated
04/23/2018
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