Healthcare Provider Details

I. General information

NPI: 1215123153
Provider Name (Legal Business Name): FEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N BRYANT AVE
EDMOND OK
73034-6307
US

IV. Provider business mailing address

9 N BRYANT AVE
EDMOND OK
73034-6307
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-0504
  • Fax:
Mailing address:
  • Phone: 405-341-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberPENDING
License Number StateOK

VIII. Authorized Official

Name: MARC E. ARNDT
Title or Position: VICE PRESIDENT
Credential:
Phone: 312-334-4462