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General NPI Number Information
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NPI Number | 1205474996
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Entity Type | Organization
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Legal Business Name | UNIVERSITY HEIGHTS MEDICAL CLINIC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 2901 AZALEA PARK DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-2283
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Country | US
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Telephone | 918-683-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 AZALEA PARK DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-2283
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Country | US
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Telephone | 918-683-6500
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Fax | 918-683-8665
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Authorized Official
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Title or Position | OWNER
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Name | DR. BYFORD F SHAW JR.
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Credential | D.O.
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Telephone | 918-683-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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