Provider Demographics
NPI:1447435458
Name:QCLINIC LLC
Entity type:Organization
Organization Name:QCLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHIAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-7500
Mailing Address - Street 1:1705 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3041
Mailing Address - Country:US
Mailing Address - Phone:405-471-6400
Mailing Address - Fax:405-471-6401
Practice Address - Street 1:12516 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1947
Practice Address - Country:US
Practice Address - Phone:405-749-9595
Practice Address - Fax:405-749-9594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QCLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-08
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5064Medicare PIN