Healthcare Provider Details

I. General information

NPI: 1275286080
Provider Name (Legal Business Name): HERITAGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7336 N CLASSEN BLVD STE 100
OKLAHOMA CITY OK
73116-7114
US

IV. Provider business mailing address

7336 N CLASSEN BLVD STE 201
OKLAHOMA CITY OK
73116-7114
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-8060
  • Fax: 405-608-8070
Mailing address:
  • Phone: 405-608-8060
  • Fax: 405-608-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON FLECK
Title or Position: CEO
Credential:
Phone: 405-608-8060