Healthcare Provider Details

I. General information

NPI: 1730128836
Provider Name (Legal Business Name): MIDWEST REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PARKLAWN DR
MIDWEST CITY OK
73110-4201
US

IV. Provider business mailing address

2825 PARKLAWN DR
MIDWEST CITY OK
73110-4201
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-4411
  • Fax:
Mailing address:
  • Phone: 405-610-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2293
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2293
License Number StateOK

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR
Credential:
Phone: 615-925-4565