Healthcare Provider Details

I. General information

NPI: 1922441591
Provider Name (Legal Business Name): MEDSTAFF PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 N ASPEN AVE SUITE 1757
BROKEN ARROW OK
74012
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-249-8776
  • Fax: 404-494-7524
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: TONY YOUNG
Title or Position: SECRETARY
Credential:
Phone: 918-779-7431