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General NPI Number Information
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NPI Number | 1295811776
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Entity Type | Organization
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Legal Business Name | QUICK MED
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 1401 S. LYNN LANE
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City | IDABEL
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State | OK
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Zip | 74745
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Country | US
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Telephone | 580-286-3278
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Fax | 580-286-3283
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Provider Business Mailing Address
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Address Line | 1400 SE ADAMS ST
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City | IDABEL
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State | OK
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Zip | 74745-5203
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Country | US
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Telephone | 580-286-3278
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Fax | 580-286-3283
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN M MIGLIACCIO
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Credential | MD
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Telephone | 580-286-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12763
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License Number State | OK
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