Healthcare Provider Details

I. General information

NPI: 1477188902
Provider Name (Legal Business Name): LHP MSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WILL ROGERS PKWY STE 300
OKLAHOMA CITY OK
73108-1839
US

IV. Provider business mailing address

11770 US HIGHWAY 1 STE 102E
PALM BEACH GARDENS FL
33408-3052
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-2678
  • Fax:
Mailing address:
  • Phone: 561-444-0710
  • Fax: 561-444-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C WHYBREW
Title or Position: SOLE MEMBER
Credential:
Phone: 918-859-5334