Organization
MCCLAIN EMERGENCY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DOMENGEAUX (GENERAL COUNCIL)
(800) 893-9698
Entity
Organization
Contact information
Practice address
1500 N GREEN AVE, PURCELL, OK 73080-1642
(800) 893-9698
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
OK
363A00000X
Physician Assistant
—
OK
363L00000X
Nurse Practitioner
—
OK
Other
Enumeration date
09/10/2015
Last updated
11/03/2015
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