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NPI Code Detail

MEDICARE: CROSSWAY MEDICAL CLINIC W MEMORIAL PLLC

MEDICARE: CROSSWAY MEDICAL CLINIC W MEMORIAL PLLC
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
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1659780526
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSWAY MEDICAL CLINIC W MEMORIAL PLLC
Provider Business Mailing Address
First Line : 609 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-2006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 609 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-2006
Country : US
Telephone Number : 405-418-5400
Fax Number :
Authorized Official
Title or Position : CEO
Name : DOUG SWIM
Credential :
Telephone Number : 405-513-7257
Provider Enumeration Date : 08/05/2014
Last Update Date : 08/06/2014

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Directions to “CROSSWAY MEDICAL CLINIC W MEMORIAL PLLC ” Practice Location

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