Provider Demographics
NPI:1063877017
Name:GILSTRAP CLINICS PC
Entity type:Organization
Organization Name:GILSTRAP CLINICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILSTRAP
Authorized Official - Suffix:
Authorized Official - Credentials:DC-APRN-CNP
Authorized Official - Phone:918-241-3901
Mailing Address - Street 1:3900 S 113TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2724
Mailing Address - Country:US
Mailing Address - Phone:918-241-3901
Mailing Address - Fax:918-241-3902
Practice Address - Street 1:3900 S 113TH WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2724
Practice Address - Country:US
Practice Address - Phone:918-241-3901
Practice Address - Fax:918-241-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care