Healthcare Provider Details

I. General information

NPI: 1922189729
Provider Name (Legal Business Name): MEDCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 S BOULEVARD ST SUITE 109
EDMOND OK
73013-5475
US

IV. Provider business mailing address

PO BOX 22656
OKLAHOMA CITY OK
73123-1656
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-1870
  • Fax: 405-562-1871
Mailing address:
  • Phone: 405-470-1884
  • Fax: 405-470-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. T DENISE CATO
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 405-470-1884