Healthcare Provider Details

I. General information

NPI: 1467836692
Provider Name (Legal Business Name): AHS OKLAHOMA PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 S MINGO RD
TULSA OK
74133-5793
US

IV. Provider business mailing address

9245 S MINGO RD
TULSA OK
74133-5793
US

V. Phone/Fax

Practice location:
  • Phone: 918-574-0250
  • Fax: 918-574-0259
Mailing address:
  • Phone: 918-574-0250
  • Fax: 918-574-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES E KALTENBACHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA, CMPE
Phone: 918-579-5008