Provider Demographics
NPI:1427140086
Name:TECUMSEH MEDICAL CLINIC PC
Entity type:Organization
Organization Name:TECUMSEH MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-598-6595
Mailing Address - Street 1:418 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873
Mailing Address - Country:US
Mailing Address - Phone:405-598-6595
Mailing Address - Fax:405-598-6103
Practice Address - Street 1:418 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873
Practice Address - Country:US
Practice Address - Phone:405-598-6595
Practice Address - Fax:405-598-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100004950AMedicaid
OK100004950AMedicaid
E09826Medicare UPIN