MEDICARE: AHS OKLAHOMA PHYSICIAN GROUP, LLC

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1689738395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHS OKLAHOMA PHYSICIAN GROUP, LLC

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE
Second Line	:	SUITE 110
City	:	TULSA
State	:	OK
Zip	:	74104-4000
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:	918-579-1262

Provider Business Practice Location Address
First Line	:	1206 MANVEL AVE
Second Line	:	SUITE C
City	:	CHANDLER
State	:	OK
Zip	:	74834-4401
Country	:	US
Telephone Number	:	405-258-5252
Fax Number	:	405-258-5552

Authorized Official
Title or Position	:	CFO
Name	:	ROBERT LANGLAND
Credential	:
Telephone Number	:	918-579-1000

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

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