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General NPI Number Information
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NPI Number | 1437799822
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Entity Type | Organization
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Legal Business Name | MUSUMA HEALTH CARE AND MEDICAL SPA, PLLC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2104 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5356
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Country | US
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Telephone | 918-964-7071
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Fax | 918-964-7072
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Provider Business Mailing Address
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Address Line | 2084 S MAIN ST STE A-8
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City | GROVE
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State | OK
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Zip | 74344-5325
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Country | US
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Telephone | 918-964-7071
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Fax | 918-964-7072
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. KAMMIE CALDWELL-WATKINS
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Credential | MD
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Telephone | 918-964-7071
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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 |
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License Number State |
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