Healthcare Provider Details

I. General information

NPI: 1770985335
Provider Name (Legal Business Name): SUMMIT MEDICAL CENTER PHYSICIANS TWO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/21/2017
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

PO BOX 258831
OKLAHOMA CITY OK
73125-8831
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2400
  • Fax:
Mailing address:
  • Phone: 405-470-6900
  • Fax: 405-470-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WADDAH NASSAR
Title or Position: OWNER
Credential: MD
Phone: 405-470-6900