Healthcare Provider Details

I. General information

NPI: 1073440442
Provider Name (Legal Business Name): MEMORIAL HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N HASKELL BLVD
HASKELL OK
74436
US

IV. Provider business mailing address

8131 S MEMORIAL DR STE 100
TULSA OK
74133-4348
US

V. Phone/Fax

Practice location:
  • Phone: 918-200-9944
  • Fax: 877-616-3089
Mailing address:
  • Phone: 918-200-9944
  • Fax: 877-616-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DYER
Title or Position: OWNER
Credential:
Phone: 918-808-5629