Healthcare Provider Details

I. General information

NPI: 1275607251
Provider Name (Legal Business Name): OKLAHOMA EM-1 MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W UNIVERSITY BLVD
DURANT OK
74701-3006
US

IV. Provider business mailing address

1717 MAIN ST 5200
DALLAS TX
75201-4612
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-3080
  • Fax:
Mailing address:
  • Phone: 214-712-2000
  • Fax: 214-712-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY BYRNE
Title or Position: PRESIDENT
Credential: MD
Phone: 214-712-2000