Eagle Community Clinic LLC

NPI #1063790202 in Edmond, Oklahoma

Provider Information

NPI Number: 1063790202
Entity Type: Organization
Organization Name: Eagle Community Clinic LLC
Subpart: Yes (part of a larger organization)
Parent Organization: OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
Primary Specialty: Family Medicine
Enumeration Date: Jul 21, 2011
Last Updated: Jul 21, 2011

Practice Location

Address: 13800 BENSON RD
Address 2: 202
City: Edmond
State: Oklahoma
ZIP Code: 73013-6422
Phone: (405) 418-3077

Authorized Official

Name: BRANDON L PENICK
Title: DIRECTOR OF REIMBURSEMENT
Phone: (405) 360-6764

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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