Provider Demographics
NPI:1649521568
Name:MICHAEL ROBINSON MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:MICHAEL ROBINSON MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-303-9060
Mailing Address - Street 1:1900 W 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4328
Mailing Address - Country:US
Mailing Address - Phone:580-303-9060
Mailing Address - Fax:877-592-0771
Practice Address - Street 1:1900 W. 2ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644
Practice Address - Country:US
Practice Address - Phone:580-303-9060
Practice Address - Fax:580-303-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty