Provider Demographics
NPI:1548459266
Name:MEDICAL CLINIC OF MCALESTER, LLC
Entity type:Organization
Organization Name:MEDICAL CLINIC OF MCALESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-423-5916
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1006
Mailing Address - Country:US
Mailing Address - Phone:918-423-5916
Mailing Address - Fax:918-423-5967
Practice Address - Street 1:320 E DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5512
Practice Address - Country:US
Practice Address - Phone:918-423-5916
Practice Address - Fax:918-423-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100069700CMedicaid
OK7048926OtherCIGNA
OK158744003OtherAR MEDICAID
OK610872700OtherDOL
OK419909840001OtherBC/BS
OK100069700CMedicaid
900522192Medicare PIN