Provider Demographics
NPI:1104097443
Name:ROWLAND-ELLIS-FLATT CLINIC
Entity type:Organization
Organization Name:ROWLAND-ELLIS-FLATT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER, PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-298-3351
Mailing Address - Street 1:603 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2636
Mailing Address - Country:US
Mailing Address - Phone:580-298-3351
Mailing Address - Fax:580-298-6137
Practice Address - Street 1:603 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2636
Practice Address - Country:US
Practice Address - Phone:580-298-3351
Practice Address - Fax:580-298-6137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0361410001Medicare NSC
=========Medicare UPIN