MEDICARE: OKLAHOMA MEDICAL AND PSYCHIATRIC SERVICES INC

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
1	283Q00000X	Psychiatric Hospital	3028	OK

General Provider Information

NPI Number	:	1083807366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA MEDICAL AND PSYCHIATRIC SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 140156
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-0002
Country	:	US
Telephone Number	:	918-492-7722
Fax Number	:	918-357-5959

Provider Business Practice Location Address
First Line	:	6646 S INDIANAPOLIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-2605
Country	:	US
Telephone Number	:	918-492-7722
Fax Number	:	918-357-5959

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK D GAGE
Credential	:	DO
Telephone Number	:	918-671-9274

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	02/04/2022

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