Healthcare Provider Details

I. General information

NPI: 1881039014
Provider Name (Legal Business Name): GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD STE 150
OKLAHOMA CITY OK
73104-3253
US

IV. Provider business mailing address

PO BOX 108835
OKLAHOMA CITY OK
73101-8835
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-4800
  • Fax: 405-418-4820
Mailing address:
  • Phone: 405-418-4800
  • Fax: 405-418-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: R. JAY CHRISTENSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 405-418-4800