NPI:
1083109037
Provider Name:
PROVISION CARES PROTON CENTER OKC, LLC
Doing Business As: PROVISION CARES PROTON CENTER OKC, LLC
Classification:
Clinic/Center - 261QX0203X
Entity Type:
Organization
Specialization: Oncology, Radiation
CLIA Number: 44D2085224
Address:
5901 W MEMORIAL RD
OKLAHOMA CITY, OK
ZIP 73142
Phone:
(865) 342-4518
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PROVISION CARES PROTON CENTER OKC, LLC is an oncology and radiation clinic center in Oklahoma City, OK. PROVISION CARES PROTON CENTER OKC, LLC NPI is 1083109037. The provider is registered as an organization entity type.
The provider Is Doing Business As Provision Cares Proton Center Okc, Llc.
The provider's business location address is:
5901 W MEMORIAL RD
OKLAHOMA CITY, OK
ZIP 73142-015
Phone: (865) 342-4518
The provider's authorized official is Valerie Gibbs .
The authorized official title is Director Of Business Operations and has the following contact phone number (865) 342-4518.
The CLIA number assigned to this NPI record is 44D2085224 - other - freestanding radiation th with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 6/22/2018 and was last updated on 6/22/2018.