Provider Demographics
NPI:1336172857
Name:PANHANDLE WOMENS CENTER P L L C
Entity type:Organization
Organization Name:PANHANDLE WOMENS CENTER P L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-338-2637
Mailing Address - Street 1:1753 N ROOSEVELT ST
Mailing Address - Street 2:PO BOX 1077
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-2729
Mailing Address - Country:US
Mailing Address - Phone:580-338-2637
Mailing Address - Fax:580-338-2652
Practice Address - Street 1:1753 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2729
Practice Address - Country:US
Practice Address - Phone:580-338-2637
Practice Address - Fax:580-338-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty