Healthcare Provider Details

I. General information

NPI: 1023358181
Provider Name (Legal Business Name): PINNACLE ONCOLOGY OKLAHOMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 32ND ST
MUSKOGEE OK
74401-5037
US

IV. Provider business mailing address

301 N 32ND ST
MUSKOGEE OK
74401
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-2000
  • Fax: 918-686-0554
Mailing address:
  • Phone: 918-683-2000
  • Fax: 918-686-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number21102
License Number StateOK

VIII. Authorized Official

Name: DR. RAVIKUMAR VASIREDDY
Title or Position: OWNER
Credential: M.D.
Phone: 918-682-1122