MEDICARE: HERITAGE PARK MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326122706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE PARK MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 25016
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73125-0016
Country	:	US
Telephone Number	:	405-737-6871
Fax Number	:	405-737-7700

Provider Business Practice Location Address
First Line	:	6908 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2128
Country	:	US
Telephone Number	:	405-737-6871
Fax Number	:	405-737-7700

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. LORI K DANKER
Credential	:
Telephone Number	:	405-737-1242

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/24/2008

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Directions to “HERITAGE PARK MEDICAL CENTER INC ” Practice Location

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