Healthcare Provider Details

I. General information

NPI: 1942671243
Provider Name (Legal Business Name): WOVEN EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E LINCOLN RD
IDABEL OK
74745-7300
US

IV. Provider business mailing address

PO BOX 98974
LAS VEGAS NV
89193-8974
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • 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: TENNA BEHM
Title or Position: OFFICER
Credential:
Phone: 469-401-2386