Provider Demographics
NPI:1548682644
Name:LADD C. ATKINS, D.O., P.L.L.C
Entity type:Organization
Organization Name:LADD C. ATKINS, D.O., P.L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LADD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-518-5522
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-0328
Mailing Address - Country:US
Mailing Address - Phone:918-473-2233
Mailing Address - Fax:
Practice Address - Street 1:9641 RIVERSIDE PKWY
Practice Address - Street 2:A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7441
Practice Address - Country:US
Practice Address - Phone:918-518-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243729206Medicare PIN