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General NPI Number Information
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NPI Number | 1992028013
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Entity Type | Organization
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Legal Business Name | OKIE STATE EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 2900 N MAIN ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4078
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Country | US
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Telephone | 973-251-1132
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Fax |
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Provider Business Mailing Address
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Address Line | 350 W CEDAR ST 4TH FLOOR
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City | PENSACOLA
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State | FL
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Zip | 32502-4910
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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 | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | OK
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