Healthcare Provider Details

I. General information

NPI: 1285105676
Provider Name (Legal Business Name): PHP OK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 W MEMORIAL PARK DR STE 100
OKLAHOMA CITY OK
73120-8371
US

IV. Provider business mailing address

13601 W MEMORIAL PARK DR STE 100
OKLAHOMA CITY OK
73120-8371
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MCKINNEY
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 405-577-6571