Provider Demographics
NPI:1194134726
Name:CHOCTAW WOMENS CLINIC PLLC
Entity type:Organization
Organization Name:CHOCTAW WOMENS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOTCHLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-620-0049
Mailing Address - Street 1:14890 SE 29TH STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020
Mailing Address - Country:US
Mailing Address - Phone:405-620-0049
Mailing Address - Fax:405-234-9476
Practice Address - Street 1:14890 SE 29TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-3515
Practice Address - Country:US
Practice Address - Phone:405-620-0049
Practice Address - Fax:405-234-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty