Provider Demographics
NPI:1205490984
Name:THEHEALTHWORXLLC
Entity type:Organization
Organization Name:THEHEALTHWORXLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-695-1187
Mailing Address - Street 1:1425 S SANTA FE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5910
Mailing Address - Country:US
Mailing Address - Phone:405-695-1187
Mailing Address - Fax:
Practice Address - Street 1:1425 S SANTA FE AVE STE G
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5910
Practice Address - Country:US
Practice Address - Phone:405-695-1187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13967262OtherCAQH