Provider Demographics
NPI:1982722195
Name:CLAREMORE HEALTH ASSOCIATES LLC
Entity type:Organization
Organization Name:CLAREMORE HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-341-1044
Mailing Address - Street 1:1408 N FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3159
Mailing Address - Country:US
Mailing Address - Phone:918-341-1044
Mailing Address - Fax:918-341-7443
Practice Address - Street 1:1408 N FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3159
Practice Address - Country:US
Practice Address - Phone:918-341-1044
Practice Address - Fax:918-341-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100120320AMedicaid
OK100150500AMedicaid
OK100069280AMedicaid
OK100069280AMedicaid
OK900522325Medicare PIN
OK100120320AMedicaid
OKC95126Medicare UPIN