Organization
OKLAHOMA INFUSION CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE LANELL AUSTIN (MEMBER)
(580) 304-6809
Entity
Organization
Contact information
Practice address
322 E GRAND AVE, PONCA CITY, OK 74601-4525
(580) 304-6809
Mailing address
2504 WILDWOOD AVE, PONCA CITY, OK 74604-4146
(580) 304-6809
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/21/2023
Last updated
04/20/2023
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