Healthcare Provider Details

I. General information

NPI: 1003127952
Provider Name (Legal Business Name): OHH PHYSICIANS SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 E I 240 SERVICE RD
OKLAHOMA CITY OK
73135-2607
US

IV. Provider business mailing address

5200 E I 240 SERVICE RD
OKLAHOMA CITY OK
73135-2607
US

V. Phone/Fax

Practice location:
  • Phone: 405-628-6000
  • Fax:
Mailing address:
  • Phone: 405-628-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK KLAKULAK
Title or Position: CFO
Credential:
Phone: 405-608-3800