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General NPI Number Information
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NPI Number | 1225037229
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Entity Type | Organization
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Legal Business Name | REGIONAL CARDIOLOGY PA
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 900 E 13TH ST SUITE 200
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City | GROVE
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State | OK
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Zip | 74344-2975
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Country | US
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Telephone | 918-786-7667
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Fax | 918-786-7699
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Provider Business Mailing Address
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Address Line | PO BOX 450968
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City | GROVE
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State | OK
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Zip | 74345-0968
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Country | US
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Telephone | 918-786-7667
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Fax | 918-786-7699
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PAUL E CALLICOAT JR.
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Credential | MD
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Telephone | 918-786-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State | OK
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