Healthcare Provider Details

I. General information

NPI: 1710009394
Provider Name (Legal Business Name): SPRINGS INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E OKLAHOMA AVE SUITE 208
ENID OK
73701-5951
US

IV. Provider business mailing address

615 E OKLAHOMA AVE SUITE 208
ENID OK
73701-5951
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-3090
  • Fax: 580-234-2090
Mailing address:
  • Phone: 580-242-3090
  • Fax: 580-234-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: NANCI E MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 580-242-3090