Healthcare Provider Details

I. General information

NPI: 1467490474
Provider Name (Legal Business Name): BMA OF OK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GREENBRIAR PKWY
OKLAHOMA CITY OK
73159
US

IV. Provider business mailing address

10301 GREENBRIAR PKWY
OKLAHOMA CITY OK
73159
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-7766
  • Fax: 405-632-7880
Mailing address:
  • Phone: 405-632-7766
  • Fax: 405-632-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-9000