Healthcare Provider Details

I. General information

NPI: 1508891789
Provider Name (Legal Business Name): CARDIOLOGY SERVICES OF ENID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S MONROE ST
ENID OK
73701-7286
US

IV. Provider business mailing address

DEPT 960278
OKLAHOMA CITY OK
73196-0278
US

V. Phone/Fax

Practice location:
  • Phone: 580-616-7630
  • Fax: 580-237-7516
Mailing address:
  • Phone: 580-548-1367
  • Fax: 580-548-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF M BROWN
Title or Position: VP RURAL PHYSICIAN PRACT MGMT
Credential:
Phone: 580-548-1367