Provider Demographics
NPI:1588284236
Name:MVP MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:MVP MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:580-271-2004
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:RATTAN
Mailing Address - State:OK
Mailing Address - Zip Code:74562-0327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 W MAIN
Practice Address - Street 2:
Practice Address - City:RATTAN
Practice Address - State:OK
Practice Address - Zip Code:74562
Practice Address - Country:US
Practice Address - Phone:580-271-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care