Healthcare Provider Details

I. General information

NPI: 1851729461
Provider Name (Legal Business Name): MEDSTAFFPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 DAVIS ST STE 126
PASADENA TX
77506-4805
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 191
TULSA OK
74134-5891
US

V. Phone/Fax

Practice location:
  • Phone: 713-534-8342
  • Fax: 404-494-7485
Mailing address:
  • Phone: 918-779-7400
  • Fax: 918-779-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP KURTZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 918-779-7431