Healthcare Provider Details

I. General information

NPI: 1265561385
Provider Name (Legal Business Name): MEASE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S 14TH STREET
JAY OK
74346
US

IV. Provider business mailing address

PO BOX 780
JAY OK
74346-0780
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-6418
  • Fax: 918-253-4066
Mailing address:
  • Phone: 918-253-6418
  • Fax: 918-253-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16931
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA151
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71128
License Number StateOK

VIII. Authorized Official

Name: DR. DARRELL R MEASE
Title or Position: OWNER
Credential: M.D.
Phone: 918-253-6418