Organization
NORTHEAST OKLAHOMA WELLNESS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVEN PARTIN (OWNER)
(918) 893-6201
Entity
Organization
Contact information
Practice address
1500 E DOWNING ST, TAHLEQUAH, OK 74464-3234
(918) 456-2594
(918) 456-3395
Mailing address
6312 E 101ST ST, TULSA, OK 74137-7007
(918) 893-6201
(918) 893-6202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
OK
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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