Healthcare Provider Details

I. General information

NPI: 1326812439
Provider Name (Legal Business Name): AFFINITY PALLIATIVE OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5627 N CLASSEN BLVD STE 100
OKLAHOMA CITY OK
73118-4031
US

IV. Provider business mailing address

5627 N CLASSEN BLVD STE 100
OKLAHOMA CITY OK
73118-4031
US

V. Phone/Fax

Practice location:
  • Phone: 405-900-7770
  • Fax: 405-730-8157
Mailing address:
  • Phone: 405-900-7770
  • Fax: 405-730-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL STERN
Title or Position: CEO
Credential:
Phone: 510-499-9977