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NPI Code Detail

MEDICARE: HEFNER WEST MEDICAL CLINIC, P.C.

MEDICARE: HEFNER WEST MEDICAL CLINIC, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1173000000XLegal Medicine11815OK

General Provider Information

NPI Number : 1003858416
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEFNER WEST MEDICAL CLINIC, P.C.
Provider Business Mailing Address
First Line : 4400 NW 63RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1545
Country : US
Telephone Number : 405-942-0090
Fax Number : 405-942-8055
Provider Business Practice Location Address
First Line : 4400 NW 63RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1545
Country : US
Telephone Number : 405-942-0090
Fax Number : 405-942-8055
Authorized Official
Title or Position : PHYSICIAN
Name : LABID SAM MUSALLAM
Credential : M.D.
Telephone Number : 405-942-0090
Provider Enumeration Date : 06/11/2006
Last Update Date : 04/20/2008

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Directions to “HEFNER WEST MEDICAL CLINIC, P.C. ” Practice Location

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