Healthcare Provider Details

I. General information

NPI: 1962670364
Provider Name (Legal Business Name): KRISTEN MARIE SAVATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S PARK LN
ALTUS OK
73521-5731
US

IV. Provider business mailing address

101 S PARK LN
ALTUS OK
73521-5731
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-6100
  • Fax: 580-379-6109
Mailing address:
  • Phone: 580-379-6100
  • Fax: 580-379-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberASA3835571
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27969
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: