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General NPI Number Information
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NPI Number | 1699104232
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Entity Type | Organization
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Legal Business Name | KEY HEALTH INSTITUTE OF EDMOND, LLC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 14701 N KELLEY AVE
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City | EDMOND
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State | OK
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Zip | 73013-3814
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Country | US
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Telephone | 405-607-5920
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Fax |
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Provider Business Mailing Address
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Address Line | 236 NW 62ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-7422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AUDRA G FOX
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Credential | M.D.
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Telephone | 405-607-5920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OK
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