Healthcare Provider Details

I. General information

NPI: 1588088157
Provider Name (Legal Business Name): MEDSTAFFPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12633 OLIVE BLVD
ST LOUIS MO
63141-6313
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 191
TULSA OK
74134-5891
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-1988
  • Fax: 314-205-1982
Mailing address:
  • Phone: 918-779-7400
  • 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: PHILIP KURTZ
Title or Position: CEO
Credential:
Phone: 918-779-7431