Provider Demographics
NPI:1568279321
Name:NORTHERN OKLAHOMA URGENT CARE
Entity type:Organization
Organization Name:NORTHERN OKLAHOMA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JANTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-231-4196
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-0008
Mailing Address - Country:US
Mailing Address - Phone:580-761-0041
Mailing Address - Fax:
Practice Address - Street 1:16603 W SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-0008
Practice Address - Country:US
Practice Address - Phone:580-761-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care