Provider Demographics
NPI:1023354842
Name:AMATTCO LLC
Entity type:Organization
Organization Name:AMATTCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-9800
Mailing Address - Street 1:3705 WEST MEMORIAL RD SUITE 601
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-751-9800
Mailing Address - Fax:405-751-9808
Practice Address - Street 1:3705 WEST MEMORIAL RD SUITE 601
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-751-7800
Practice Address - Fax:405-751-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24935261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center