Healthcare Provider Details

I. General information

NPI: 1922509173
Provider Name (Legal Business Name): MERCY OKLAHOMA AMBULATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SW 19TH ST
MOORE OK
73160-3049
US

IV. Provider business mailing address

PO BOX 775633
CHICAGO IL
60677-5633
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL MCCART
Title or Position: VP - ACCOUNTING
Credential:
Phone: 314-364-3891