Provider Demographics
NPI:1942691175
Name:RHEUMATIC DISEASES CLINIC OF OKLAHOMA, PLLC
Entity type:Organization
Organization Name:RHEUMATIC DISEASES CLINIC OF OKLAHOMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BERENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-323-7134
Mailing Address - Street 1:PO BOX 2237
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-2237
Mailing Address - Country:US
Mailing Address - Phone:405-606-8070
Mailing Address - Fax:405-606-6350
Practice Address - Street 1:1015 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1021
Practice Address - Country:US
Practice Address - Phone:405-606-8070
Practice Address - Fax:405-606-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty