Healthcare Provider Details

I. General information

NPI: 1285033282
Provider Name (Legal Business Name): OKLAHOMA ESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E JOSEPHINE AVE
FREDERICK OK
73542-2220
US

IV. Provider business mailing address

17304 PRESTON RD SUITE 1400
DALLAS TX
75252-5618
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-7565
  • Fax:
Mailing address:
  • Phone: 972-934-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RON WEISS
Title or Position: CEO
Credential:
Phone: 972-934-3200