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NPI Code Detail

MEDICARE: OKC GYN/OB LLC

MEDICARE: OKC GYN/OB LLC
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
1207VG0400XGynecology Physician

General Provider Information

NPI Number : 1083557839
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKC GYN/OB LLC
Provider Business Mailing Address
First Line : 11200 N PORTLAND AVE FL 2
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5045
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11200 N PORTLAND AVE FL 2
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5045
Country : US
Telephone Number : 405-936-1151
Fax Number : 405-936-1001
Authorized Official
Title or Position : BILLING OFFICE
Name : MS. PAM JEAN HODGES
Credential :
Telephone Number : 405-936-1151
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “OKC GYN/OB LLC ” Practice Location

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