Provider Demographics
NPI:1215704192
Name:KAIMO ENTERPRISES LLC
Entity type:Organization
Organization Name:KAIMO ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGREST
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-664-6225
Mailing Address - Street 1:7201 SE 164TH ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2791
Mailing Address - Country:US
Mailing Address - Phone:405-664-6225
Mailing Address - Fax:
Practice Address - Street 1:2328 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2991
Practice Address - Country:US
Practice Address - Phone:405-857-2179
Practice Address - Fax:405-310-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center