Healthcare Provider Details

I. General information

NPI: 1205884145
Provider Name (Legal Business Name): TSG PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308B W HIGHWAY 66
STROUD OK
74079-6729
US

IV. Provider business mailing address

PO BOX 12277
OKLAHOMA CITY OK
73157-2277
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-4469
  • Fax:
Mailing address:
  • Phone: 405-917-0300
  • Fax: 405-917-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS RICE
Title or Position: CEO
Credential:
Phone: 405-917-0300