MEDICARE: FALLS PARK CHRISTIAN 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	208600000X	Surgery Physician	14183	OK

General Provider Information

NPI Number	:	1629090584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLS PARK CHRISTIAN MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	6102 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7526
Country	:	US
Telephone Number	:	405-728-8450
Fax Number	:	405-721-6749

Provider Business Practice Location Address
First Line	:	6102 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7526
Country	:	US
Telephone Number	:	405-728-8450
Fax Number	:	405-721-6749

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH E GREGORY
Credential	:	MD
Telephone Number	:	405-728-8450

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	12/12/2007

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