Healthcare Provider Details

I. General information

NPI: 1205816048
Provider Name (Legal Business Name): SOUTHCREST EMERGENCY PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S 101ST EAST AVE
TULSA OK
74133-5716
US

IV. Provider business mailing address

PO BOX 5358
NORMAN OK
73070-5358
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-4000
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: STAN STACY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 918-294-4000