Healthcare Provider Details

I. General information

NPI: 1588846786
Provider Name (Legal Business Name): PHIL JOSEPH VILAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CLARK BASS BLVD
MCALESTER OK
74501-4209
US

IV. Provider business mailing address

1340 VIRETON RD
MCALESTER OK
74501-8806
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-1800
  • Fax:
Mailing address:
  • Phone: 918-423-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number686634
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number94107
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: