=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528152899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOVASCULAR CONSULTANTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5555 E 71 STREET SUITE 7200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-496-1907
-----------------------------------------------------
Fax | 918-496-8437
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5555 E 71 STREET SUITE 7200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-496-1907
-----------------------------------------------------
Fax | 918-496-8437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | GREGORY JAN MCWILLIAMS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 918-496-1907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 1724
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------