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General NPI Number Information
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NPI Number | 1255344206
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN EMERGENCY DEPARTMENT PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5602 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-9635
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Country | US
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Telephone | 580-531-4700
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Fax | 580-531-4889
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Provider Business Mailing Address
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Address Line | 4401 W MEMORIAL RD SUITE 121
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1785
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Country | US
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Telephone | 405-751-4664
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Fax | 405-749-4561
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GEORGE KRUGER
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Credential |
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Telephone | 580-531-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2231
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License Number State | OK
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