Organization
LESLIE CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PORTER BASS LESLIE M.D. (MEDICAL DOCTOR/PRACTICE OWNER)
(580) 995-3200
Entity
Organization
Contact information
Practice address
RR 1 BOX A1, VICI, OK 73859-9106
(580) 995-3200
(580) 995-3202
Mailing address
PO BOX 45, VICI, OK 73859-0045
(580) 995-3200
(580) 995-3202
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
10616
OK
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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