=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538125521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED PHYSICIANS GROUP INC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 06/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6824 NW 23RD ST
-----------------------------------------------------
City | BETHANY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73008-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-495-5154
-----------------------------------------------------
Fax | 405-603-2313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6820 NW 23RD ST
-----------------------------------------------------
City | BETHANY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73008-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-495-5154
-----------------------------------------------------
Fax | 405-603-2313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. BRENT D SIEMENS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 405-495-5154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------