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General NPI Number Information
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NPI Number | 1609003409
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Entity Type | Organization
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Legal Business Name | OKLAHOMA ALGIATRY GROUP
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE STE 301
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City | EDMOND
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State | OK
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Zip | 73034-6331
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Country | US
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Telephone | 405-509-6241
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Fax | 405-509-6242
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Provider Business Mailing Address
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Address Line | PO BOX 30635
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City | EDMOND
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State | OK
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Zip | 73003-0011
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Country | US
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Telephone | 405-509-6241
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Fax | 405-509-6242
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Authorized Official
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Title or Position | DIRECTOR/MANAGER/COO
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Name | MISS KIMBERLY KAY MURRY
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Credential | RN, BSN
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Telephone | 405-509-6241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OK19307
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License Number State | OK
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