MEDICARE: MERCY MEMORIAL EMERGENCY PHYSICIANS PC

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	207P00000X	Emergency Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK6850	OTHER	OK	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801858931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEMORIAL EMERGENCY PHYSICIANS PC

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE 121
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-751-4664
Fax Number	:	405-749-4561

Provider Business Practice Location Address
First Line	:	1011 14TH AVE NW
Second Line	:	ER DEPT.
City	:	ARDMORE
State	:	OK
Zip	:	73401-1828
Country	:	US
Telephone Number	:	580-220-6415
Fax Number	:	405-749-4561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL DEAN ORCUTT
Credential	:	M.D.
Telephone Number	:	405-751-4664

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/22/2020

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Directions to “MERCY MEMORIAL EMERGENCY PHYSICIANS PC ” Practice Location

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