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General NPI Number Information
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NPI Number | 1760702153
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Entity Type | Organization
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Legal Business Name | PREMIER HOSPITALISTS PC
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 13401 W SIMMONS RD
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City | EDMOND
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State | OK
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Zip | 73025-8565
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Country | US
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Telephone | 405-401-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 13401 W SIMMONS RD
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City | EDMOND
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State | OK
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Zip | 73025-8565
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Country | US
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Telephone | 405-401-6334
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. MARK WOODSON
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Credential | MD
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Telephone | 405-401-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 19384
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License Number State | OK
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