Healthcare Provider Details

I. General information

NPI: 1467883447
Provider Name (Legal Business Name): MEDSTAFFPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 E 590 RD
INOLA OK
74036-3222
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 191
TULSA OK
74134-5891
US

V. Phone/Fax

Practice location:
  • Phone: 918-543-6313
  • Fax: 866-852-0361
Mailing address:
  • Phone: 918-779-7400
  • Fax: 918-779-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP KURTZ
Title or Position: CEO
Credential:
Phone: 918-779-7431