Healthcare Provider Details

I. General information

NPI: 1245353713
Provider Name (Legal Business Name): TRICITIES MEDICAL & SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S INDIAN RD
WEWOKA OK
74884-9781
US

IV. Provider business mailing address

PO BOX 1221
WEWOKA OK
74884-1221
US

V. Phone/Fax

Practice location:
  • Phone: 405-257-6272
  • Fax: 405-257-6273
Mailing address:
  • Phone: 405-257-6272
  • Fax: 405-257-6273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA SUE MADRON
Title or Position: CLINIC MANAGER
Credential:
Phone: 405-257-6272