Healthcare Provider Details

I. General information

NPI: 1912717711
Provider Name (Legal Business Name): W MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 BROADWAY EXT STE A
OKLAHOMA CITY OK
73114-6307
US

IV. Provider business mailing address

6608 N WESTERN AVE # 416
NICHOLS HILLS OK
73116-7326
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-5950
  • Fax: 405-607-3580
Mailing address:
  • Phone: 405-748-5950
  • Fax: 405-607-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN WAYNE
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 405-748-5950