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General NPI Number Information
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NPI Number | 1386607216
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Entity Type | Organization
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Legal Business Name | PACIFIC PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 8803 S 101ST EAST AVE STE. 145
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-250-2033
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Fax |
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Provider Business Mailing Address
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Address Line | 8803 S 101ST EAST AVE STE. 145
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-250-2033
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
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Name | DEBBIE BREWER
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Credential |
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Telephone | 615-465-7626
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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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