Healthcare Provider Details

I. General information

NPI: 1669874228
Provider Name (Legal Business Name): SUMMIT MEDICAL CENTER PHYSICIANS ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 03/16/2018
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: 405-470-6901
Mailing address:
  • Phone: 405-470-6900
  • Fax: 405-470-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number102310
License Number StateOK

VIII. Authorized Official

Name: DEBRA L RHODES
Title or Position: CLINIC MANAGER
Credential:
Phone: 405-470-6900