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NPI Code Detail

MEDICARE: MEDSTAFF

MEDICARE: MEDSTAFF
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1205268380
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDSTAFF
Provider Business Mailing Address
First Line : 4500 S 129TH EAST AVE STE 191
Second Line :
City : TULSA
State : OK
Zip : 74134-5891
Country : US
Telephone Number : 918-779-7900
Fax Number : 918-779-7425
Provider Business Practice Location Address
First Line : 4705 S 129TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-7005
Country : US
Telephone Number : 918-615-7020
Fax Number : 918-615-7022
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : RON WOODS
Credential :
Telephone Number : 918-779-7428
Provider Enumeration Date : 07/31/2013
Last Update Date : 07/31/2013

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Directions to “MEDSTAFF ” Practice Location

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