Healthcare Provider Details

I. General information

NPI: 1346684487
Provider Name (Legal Business Name): MEDSTAFF PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 W FAIRVIEW AVE
CARTHAGE MO
64836-3731
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 191
TULSA OK
74134-5801
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-8131
  • Fax: 404-698-2614
Mailing address:
  • Phone: 918-779-7900
  • Fax: 918-779-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY YOUNG
Title or Position: SECRETARY
Credential:
Phone: 918-779-7431