Healthcare Provider Details

I. General information

NPI: 1801170212
Provider Name (Legal Business Name): OKLAHOMA SLEEP INSTITUTE CLINIC - MWC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 NATIONAL AVE SUITE 208
MIDWEST CITY OK
73110-7530
US

IV. Provider business mailing address

13900 WIRELESS WAY
OKLAHOMA CITY OK
73134-2505
US

V. Phone/Fax

Practice location:
  • Phone: 405-443-3594
  • Fax: 405-606-7040
Mailing address:
  • Phone: 405-606-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR0058479
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR0058479
License Number StateOK

VIII. Authorized Official

Name: MICHAEL C GOLD
Title or Position: PRESIDENT
Credential:
Phone: 405-606-2727