=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528629813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDEFY HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2019
-----------------------------------------------------
Last Update Date | 07/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8596 E 101ST ST STE C
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-7037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-770-8822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 E 5TH ST STE 2701
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74103-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-770-8822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MATTHEW SCOVIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-710-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------