Provider Demographics
NPI:1568282838
Name:RURAL WELLNESS STROUD CLINIC INC
Entity type:Organization
Organization Name:RURAL WELLNESS STROUD CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-322-4337
Mailing Address - Street 1:2524 N BROADWAY # 496
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4172
Mailing Address - Country:US
Mailing Address - Phone:949-322-4337
Mailing Address - Fax:
Practice Address - Street 1:2308B W HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-6729
Practice Address - Country:US
Practice Address - Phone:918-968-1642
Practice Address - Fax:918-968-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty