Healthcare Provider Details

I. General information

NPI: 1215324553
Provider Name (Legal Business Name): CARDIOVASCULAR HEALTH CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 QUAIL SPRINGS PARKWAY STE 200
OKLAHOMA CITY OK
73134
US

IV. Provider business mailing address

3200 QUAIL SPRINGS PARKWAY STE 200
OKLAHOMA CITY OK
73134
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-9880
  • Fax: 405-701-9881
Mailing address:
  • Phone: 405-701-9880
  • Fax: 405-701-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number3168
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14792
License Number StateOK

VIII. Authorized Official

Name: DR. DWAYNE A SCHMIDT
Title or Position: MEMBER
Credential: MD
Phone: 405-823-3229