Healthcare Provider Details

I. General information

NPI: 1902866288
Provider Name (Legal Business Name): PHOENIX PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD ER DEPT.
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE 121
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-3733
  • Fax: 405-749-4561
Mailing address:
  • Phone: 405-751-4664
  • Fax: 405-749-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL DEAN ORCUTT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-751-4664