Provider Demographics
NPI:1649479627
Name:GUTHRIE CLINIC, INC.
Entity type:Organization
Organization Name:GUTHRIE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, APRN
Authorized Official - Phone:918-967-4697
Mailing Address - Street 1:2000 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-3041
Mailing Address - Country:US
Mailing Address - Phone:918-962-2439
Mailing Address - Fax:918-967-8847
Practice Address - Street 1:2000 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-3041
Practice Address - Country:US
Practice Address - Phone:918-962-2439
Practice Address - Fax:918-967-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2510111N00000X
OKR0100325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522271OtherMEDICARE GROUP NUMBER