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General NPI Number Information
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NPI Number | 1477009256
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Entity Type | Organization
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Legal Business Name | AMATTCO LLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 3100 S ELM PL SUITE B
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7950
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Country | US
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Telephone | 918-884-7800
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Fax | 918-731-4518
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Provider Business Mailing Address
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Address Line | 3705 WEST MEMORIAL RD SUITE 601
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1512
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Country | US
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Telephone | 405-751-9800
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Fax | 405-751-9808
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Authorized Official
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Title or Position | SUPERVISING PHYSICAN
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Name | DR. DAVID RYKER SR.
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Credential | MD
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Telephone | 405-751-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9365
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 79139
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R0078723
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 86262
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 73548
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License Number State | OK
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