Healthcare Provider Details

I. General information

NPI: 1205208535
Provider Name (Legal Business Name): PHOENIX MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 HARRISON ST
PAWNEE OK
74058-2566
US

IV. Provider business mailing address

1141 N ROBINSON AVE 101A
OKLAHOMA CITY OK
73103-4929
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-5050
  • Fax: 877-515-8550
Mailing address:
  • Phone: 405-601-6181
  • Fax: 405-601-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KINYADA SINGLETON
Title or Position: MANAGING PARTNER
Credential:
Phone: 405-601-6181