Ok4 Ft. Gibson Opco LLC

Practice location

Address

205 E Poplar St, Fort Gibson, OK 74434-8272

Phone

(918) 478-2456

Mailing address

2045 W Grand Ave STE B-34572, Chicago, IL 60612-1576

Authorised official

Name

Isaac Dole

Title

Manager/Principal

Phone

(773) 645-9246

Registered specialties

Registry record

NPI

1215382734

Entity type

Organization

NPI issued

3 May 2016

Record last updated

29 Oct 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.