Healthcare Provider Details

I. General information

NPI: 1033429436
Provider Name (Legal Business Name): MISSION PHYSICIAN SERVICES OF CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 S PEORIA AVE STE 101
TULSA OK
74105-2006
US

IV. Provider business mailing address

3220 S PEORIA AVE STE 101
TULSA OK
74105-2006
US

V. Phone/Fax

Practice location:
  • Phone: 918-770-4441
  • Fax: 918-712-9880
Mailing address:
  • Phone: 918-770-4441
  • Fax: 918-712-9880

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: MR. KEVIN M. WEBB
Title or Position: PRESIDENT
Credential:
Phone: 918-770-4441