Healthcare Provider Details

I. General information

NPI: 1083807366
Provider Name (Legal Business Name): OKLAHOMA MEDICAL AND PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6646 S INDIANAPOLIS AVE
TULSA OK
74136-2605
US

IV. Provider business mailing address

PO BOX 140156
BROKEN ARROW OK
74014-0002
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-7722
  • Fax: 918-357-5959
Mailing address:
  • Phone: 918-492-7722
  • Fax: 918-357-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number3028
License Number StateOK

VIII. Authorized Official

Name: DR. MARK D GAGE
Title or Position: OWNER
Credential: DO
Phone: 918-671-9274