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General NPI Number Information
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NPI Number | 1134386626
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Entity Type | Organization
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Legal Business Name | MUSKOGEE PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 300 ROCKEFELLER DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-5075
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Country | US
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Telephone | 615-620-2320
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Fax | 615-620-2323
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Provider Business Mailing Address
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Address Line | PO BOX 840633
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City | DALLAS
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State | TX
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Zip | 75284-0633
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Country | US
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Telephone | 615-620-2320
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Fax | 615-620-2323
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SCOTT ROBERTS
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Credential |
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Telephone | 615-620-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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