Provider Demographics
NPI:1902426737
Name:CREEKSIDE URGENT CARE LLC
Entity type:Organization
Organization Name:CREEKSIDE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:405-285-2161
Mailing Address - Street 1:1101 NW 178TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4281
Mailing Address - Country:US
Mailing Address - Phone:405-285-2161
Mailing Address - Fax:405-726-8277
Practice Address - Street 1:1101 NW 178TH ST STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4281
Practice Address - Country:US
Practice Address - Phone:405-285-2161
Practice Address - Fax:405-726-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty