Provider Demographics
NPI:1174949317
Name:SOVEREIGN MEDICAL CLINIC NORMAN
Entity type:Organization
Organization Name:SOVEREIGN MEDICAL CLINIC NORMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF SOVEREIGN MEDICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-421-9500
Mailing Address - Street 1:2080 STATE HWY 9 WEST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9847
Mailing Address - Country:US
Mailing Address - Phone:405-322-6800
Mailing Address - Fax:405-322-6803
Practice Address - Street 1:2080 HWY 9 WEST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-322-6800
Practice Address - Fax:405-322-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care