Organization
TEAM CLINICS AH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR ALLEN NUTT (CEO)
(405) 540-4130
Entity
Organization
Contact information
Practice address
42400 GARRETTS LAKE RD, SHAWNEE, OK 74804-9301
(405) 275-3473
Mailing address
3112 COOKE WAY, OKLAHOMA CITY, OK 73179-2401
(405) 546-4130
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200920640
—
OK
Enumeration date
09/25/2023
Last updated
09/25/2023
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