Healthcare Provider Details

I. General information

NPI: 1043595374
Provider Name (Legal Business Name): OBHG OKLAHOMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

777 LOWNDES HILL RD BLDG 1
GREENVILLE SC
29607-2131
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2345
  • Fax: 864-627-9920
Mailing address:
  • Phone: 800-967-2289
  • Fax: 864-627-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLIFF LAWRENCE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 800-967-2289