Healthcare Provider Details

I. General information

NPI: 1811006455
Provider Name (Legal Business Name): DEACONESS FAMILY CARE WEST HEFNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 W HEFNER RD
OKLAHOMA CITY OK
73162-4505
US

IV. Provider business mailing address

7221 W HEFNER RD
OKLAHOMA CITY OK
73162-4505
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-6900
  • Fax: 405-470-6900
Mailing address:
  • Phone: 405-470-6900
  • Fax: 405-470-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WADDAH N. NASSAR
Title or Position: OWNER
Credential: MD
Phone: 405-470-6900