Healthcare Provider Details

I. General information

NPI: 1023259710
Provider Name (Legal Business Name): MARCUS MUNROE GRIFFIN CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

1810 SAVANNAH DR
FORT SMITH AR
72901-8545
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7113
Mailing address:
  • Phone: 479-414-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: