Healthcare Provider Details

I. General information

NPI: 1508486309
Provider Name (Legal Business Name): MILLENNIUM MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N 8TH ST
DUNCAN OK
73533-4601
US

IV. Provider business mailing address

3816 SHADOWRIDGE DR
NORMAN OK
73072-5308
US

V. Phone/Fax

Practice location:
  • Phone: 888-573-7795
  • Fax:
Mailing address:
  • Phone: 888-573-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WADE L HAMIL
Title or Position: CEO
Credential:
Phone: 405-573-9905