Provider Demographics
NPI:1063180750
Name:OKIES CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:OKIES CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-200-6966
Mailing Address - Street 1:1050 RUTLEDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-3027
Mailing Address - Country:US
Mailing Address - Phone:423-200-6966
Mailing Address - Fax:865-932-7775
Practice Address - Street 1:1050 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-3027
Practice Address - Country:US
Practice Address - Phone:423-200-6966
Practice Address - Fax:865-932-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty