=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821308248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHS OKLAHOMA PHYSICIAN GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2010
-----------------------------------------------------
Last Update Date | 10/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 N HIGHWAY 66 STE B
-----------------------------------------------------
City | CATOOSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74015-3074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-266-4433
-----------------------------------------------------
Fax | 918-266-4244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1145 S UTICA AVE SUITE 110
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-579-3826
-----------------------------------------------------
Fax | 918-579-1262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DANIEL RAMSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-579-5008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------