Healthcare Provider Details

I. General information

NPI: 1164586038
Provider Name (Legal Business Name): AHS OKLAHOMA PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 S ELM PL
BROKEN ARROW OK
74012-7850
US

IV. Provider business mailing address

1145 S UTICA AVE SUITE 110
TULSA OK
74104-4000
US

V. Phone/Fax

Practice location:
  • Phone: 918-455-8545
  • Fax: 918-455-2521
Mailing address:
  • Phone: 918-579-3825
  • Fax: 918-579-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LANGLAND
Title or Position: CFO
Credential:
Phone: 918-579-1000