Healthcare Provider Details

I. General information

NPI: 1194971960
Provider Name (Legal Business Name): OKLAHOMA PROCURE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

PO BOX 877435
KANSAS CITY MO
64187-7435
US

V. Phone/Fax

Practice location:
  • Phone: 405-773-6700
  • Fax: 405-720-3910
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW C KNIZLEY
Title or Position: PRESIDENT
Credential:
Phone: 405-773-6712