Healthcare Provider Details

I. General information

NPI: 1295858918
Provider Name (Legal Business Name): MUSKOGEE PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROCKEFELLER DR
MUSKOGEE OK
74401-5075
US

IV. Provider business mailing address

500 CORPORATE CENTRE DR STE. 200
FRANKLIN TN
37067-6219
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-5501
  • Fax: 918-684-2552
Mailing address:
  • Phone: 615-764-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL S. SLIPKOVICH
Title or Position: CEO
Credential:
Phone: 615-764-3000