Provider Demographics
NPI:1194570234
Name:GORE NITROGEN PUMPING SERVICE, LLC
Entity type:Organization
Organization Name:GORE NITROGEN PUMPING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:HEALTH &
Authorized Official - Last Name:AKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:580-922-1385
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0065
Mailing Address - Country:US
Mailing Address - Phone:580-922-4667
Mailing Address - Fax:435-586-5368
Practice Address - Street 1:916 N ELM ST
Practice Address - Street 2:
Practice Address - City:SEILING
Practice Address - State:OK
Practice Address - Zip Code:73663-6345
Practice Address - Country:US
Practice Address - Phone:580-922-1385
Practice Address - Fax:435-586-5368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GORE NITROGEN PUMPING SERVICE, LLC/WILLOW HEALTH & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care