Healthcare Provider Details

I. General information

NPI: 1326122706
Provider Name (Legal Business Name): HERITAGE PARK MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 E RENO AVE
MIDWEST CITY OK
73110-2128
US

IV. Provider business mailing address

PO BOX 25016
OKLAHOMA CITY OK
73125-0016
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-6871
  • Fax: 405-737-7700
Mailing address:
  • Phone: 405-737-6871
  • Fax: 405-737-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI K DANKER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 405-737-1242