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General NPI Number Information
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NPI Number | 1780908905
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Entity Type | Organization
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Legal Business Name | PREVENTATIVE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 1305 N HIGHWAY 66 SUITE B
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City | CATOOSA
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State | OK
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Zip | 74015-2460
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Country | US
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Telephone | 918-955-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 N HIGHWAY 66 SUITE B
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City | CATOOSA
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State | OK
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Zip | 74015-2460
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Country | US
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Telephone | 918-955-0224
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | AMY GLENN
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Credential |
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Telephone | 918-739-4767
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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 |
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License Number State |
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