Provider Demographics
NPI:1154022689
Name:URGENT CARE OF GRAND LAKE PLLC
Entity type:Organization
Organization Name:URGENT CARE OF GRAND LAKE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:918-552-5546
Mailing Address - Street 1:900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2844
Mailing Address - Country:US
Mailing Address - Phone:918-552-5546
Mailing Address - Fax:
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2844
Practice Address - Country:US
Practice Address - Phone:918-232-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care