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General NPI Number Information
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NPI Number | 1497093959
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Entity Type | Organization
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Legal Business Name | SMH PHYSICIAN GROUP, LLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 213 E REDWOOD AVE
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City | SALLISAW
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State | OK
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Zip | 74955-2811
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Country | US
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Telephone | 918-774-1100
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Fax | 918-774-1103
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Provider Business Mailing Address
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Address Line | 213 E REDWOOD AVE
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City | SALLISAW
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State | OK
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Zip | 74955-2811
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Country | US
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Telephone | 918-774-1100
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Fax | 918-774-1103
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Authorized Official
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Title or Position | CEO
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Name | DEBRA R. KNOKE
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Credential |
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Telephone | 918-774-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2189
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License Number State | OK
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