Healthcare Provider Details

I. General information

NPI: 1053445593
Provider Name (Legal Business Name): MUSKOGEE HEART CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

IV. Provider business mailing address

3340 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

V. Phone/Fax

Practice location:
  • Phone: 918-687-6002
  • Fax: 918-687-6216
Mailing address:
  • Phone: 918-687-6002
  • Fax: 918-687-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KELLEY DEHNHARDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-687-6002