Organization
SALLISAW MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMELIA L POITEVINT (OWNER)
(918) 790-2890
Entity
Organization
Contact information
Practice address
202 E CHEROKEE AVE, SALLISAW, OK 74955-4600
(918) 790-2890
(918) 790-2906
Mailing address
202 E CHEROKEE AVE, SALLISAW, OK 74955-4600
(918) 790-2890
(918) 790-2906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4825
OK
207Q00000X
Family Medicine Physician
4840
OK
363LF0000X
Family Nurse Practitioner
R0074165
OK
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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