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General NPI Number Information
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NPI Number | 1083807366
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Entity Type | Organization
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Legal Business Name | OKLAHOMA MEDICAL AND PSYCHIATRIC SERVICES INC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 6646 S INDIANAPOLIS AVE
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City | TULSA
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State | OK
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Zip | 74136-2605
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Country | US
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Telephone | 918-492-7722
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Fax | 918-357-5959
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Provider Business Mailing Address
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Address Line | PO BOX 140156
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City | BROKEN ARROW
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State | OK
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Zip | 74014-0002
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Country | US
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Telephone | 918-492-7722
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Fax | 918-357-5959
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK D GAGE
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Credential | DO
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Telephone | 918-671-9274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 3028
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License Number State | OK
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