MEDICARE: TAF ANCILLARY MEDICAL SERVICES CO

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1316105844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAF ANCILLARY MEDICAL SERVICES CO

Provider Business Mailing Address
First Line	:	RR 1 BOX 469
Second Line	:
City	:	TERLTON
State	:	OK
Zip	:	74081-9738
Country	:	US
Telephone Number	:	918-865-7177
Fax Number	:	918-865-7177

Provider Business Practice Location Address
First Line	:	300 W OSAGE ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4609
Country	:	US
Telephone Number	:	918-865-7177
Fax Number	:	918-865-7177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AILEEN R BURGESS
Credential	:
Telephone Number	:	918-214-6699

Provider Enumeration Date	:	05/31/2008
Last Update Date	:	05/31/2008

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Directions to “TAF ANCILLARY MEDICAL SERVICES CO ” Practice Location

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