Organization
TEAM CLINICS AH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR ALLEN NUTT (CEO)
(405) 601-6767
Entity
Organization
Contact information
Practice address
705 HIGHWAY 70 N, KINGSTON, OK 73439-8207
(405) 546-4130
Mailing address
3112 COOKE WAY, OKLAHOMA CITY, OK 73179-2401
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200782030
—
OK
Enumeration date
11/28/2023
Last updated
11/28/2023
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