Healthcare Provider Details

I. General information

NPI: 1639493315
Provider Name (Legal Business Name): OKLAHOMA EM - 1 MEDICAL SERVICES,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 N 110TH EAST AVE
OWASSO OK
74055-6655
US

IV. Provider business mailing address

1717 MAIN ST
DALLAS TX
75201-4612
US

V. Phone/Fax

Practice location:
  • Phone: 918-376-8100
  • Fax: 405-878-8101
Mailing address:
  • Phone: 214-712-2448
  • Fax: 214-712-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERGORY J BYRNE
Title or Position: PRESIDENT
Credential:
Phone: 214-712-2000