Healthcare Provider Details

I. General information

NPI: 1114117561
Provider Name (Legal Business Name): EDMOND HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

3 MARYLAND FARMS SUITE 250
BRENTWOOD TN
37027-5005
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-5370
  • Fax: 405-359-5357
Mailing address:
  • Phone: 615-372-5068
  • Fax: 866-829-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN LAVERTY
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-372-5068