Provider Demographics
NPI:1699421941
Name:RUFFIN MEDICINE LLC
Entity type:Organization
Organization Name:RUFFIN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-281-6065
Mailing Address - Street 1:11124 NE 5TH ST # NA
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7701
Mailing Address - Country:US
Mailing Address - Phone:405-281-6065
Mailing Address - Fax:
Practice Address - Street 1:1940 HARPER ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8095
Practice Address - Country:US
Practice Address - Phone:405-281-6065
Practice Address - Fax:405-281-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072870BMedicaid