Healthcare Provider Details

I. General information

NPI: 1003872482
Provider Name (Legal Business Name): MERCY HEALTH SERVICES-SOUTHERN REGION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 15TH AVE NW
ARDMORE OK
73401-1810
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE #141; ATTN: BECKY
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-3737
  • Fax: 580-226-5679
Mailing address:
  • Phone: 405-936-5811
  • Fax: 405-936-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A. NAFZIGER
Title or Position: VP/CFO
Credential:
Phone: 405-752-3724