Mission Street Medical Clinic Inc

LBN: Mission Street Medical Clinic Inc
Mission Street Medical Clinic Inc is an health care organization with primary practice located at 615 S Mission St Ste A , Sapulpa OK 74066-4635. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Mission Street Medical Clinic Inc can be contacted via phone (918) 224-9555, or through Willis, Dianna M via phone (918) 224-9555.

Contact Information

Primary practice address
615 S Mission St Ste A Sapulpa OK 74066-4635
Phone: (918) 224-9555
Fax: (918) 224-8001
Website:
Map and Directions
Authorized official contact:
Name: Willis, Dianna M Doctor of Osteopathy (DO)
Phone: (918) 224-9555

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2405 Oklahoma

Profile Details

NPI number 1972600112
LBN Legal business name Mission Street Medical Clinic Inc
DBA Doing business as
Authorized official Willis, Dianna M Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 20th, 2006
Last updated Dec 30th, 2010 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972600112 NPPES
Oklahoma MEDICAID 100739110A
Oklahoma Other C05052

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