MEDICARE: AHS OKLAHOMA PHYSICIAN GROUP, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841354461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHS OKLAHOMA PHYSICIAN GROUP, LLC

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE
Second Line	:	SUITE 110
City	:	TULSA
State	:	OK
Zip	:	74104-4000
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:	918-579-1262

Provider Business Practice Location Address
First Line	:	201 N MAIN ST
Second Line	:
City	:	YALE
State	:	OK
Zip	:	74085-2509
Country	:	US
Telephone Number	:	918-387-2407
Fax Number	:	918-387-2011

Authorized Official
Title or Position	:	MEDICAL STAFF AFFAIRS COORDINATOR
Name	:	ROBERT LANGLAND
Credential	:
Telephone Number	:	918-579-3825

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

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