Provider Demographics
NPI:1528351780
Name:B3W LLC
Entity type:Organization
Organization Name:B3W LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-419-8448
Mailing Address - Street 1:115 N MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3912
Mailing Address - Country:US
Mailing Address - Phone:405-256-5595
Mailing Address - Fax:405-256-5596
Practice Address - Street 1:115 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3912
Practice Address - Country:US
Practice Address - Phone:405-256-5595
Practice Address - Fax:405-265-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care