Organization
TEAM CLINICS ANCILLARY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR NUTT (CEO)
(405) 546-4130
Entity
Organization
Contact information
Practice address
3112 COOKE WAY, OKLAHOMA CITY, OK 73179-2401
(405) 546-4130
Mailing address
201 ROBERT S KERR AVE STE 1600, OKLAHOMA CITY, OK 73102-4216
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201104850A
—
OK
Enumeration date
04/08/2021
Last updated
10/06/2022
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