MEDICARE: MEDSTAFFPC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447697578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAFFPC

Provider Business Mailing Address
First Line	:	4500 S 129TH EAST AVE
Second Line	:	STE 191
City	:	TULSA
State	:	OK
Zip	:	74134-5801
Country	:	US
Telephone Number	:	918-779-7900
Fax Number	:	918-779-7425

Provider Business Practice Location Address
First Line	:	410 N MAIN ST
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9216
Country	:	US
Telephone Number	:	574-825-5002
Fax Number	:	574-825-2055

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RON WOODS
Credential	:
Telephone Number	:	918-779-7428

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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