Healthcare Provider Details

I. General information

NPI: 1609632025
Provider Name (Legal Business Name): JOSEPH REMSBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 08/06/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97TH MEDICAL GROUP 301 N FIRST ST
ALTUS AFB OK
73523
US

IV. Provider business mailing address

97TH MEDICAL GROUP 301 N FIRST ST
ALTUS AFB OK
73523
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-6782
  • Fax:
Mailing address:
  • Phone: 580-481-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10270
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: