Organization
TEAM CLINICS AH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR NUTT (CEO)
(405) 546-4130
Entity
Organization
Contact information
Practice address
412 S 9TH ST, BROKEN ARROW, OK 74012-4410
(405) 546-4130
Mailing address
3112 COOKE WAY, OKLAHOMA CITY, OK 73179-2401
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200782030
—
OK
Enumeration date
08/30/2021
Last updated
08/30/2021
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