Provider Demographics
NPI:1023218468
Name:GREGORY C KHOURY MD AMPC
Entity Type:Organization
Organization Name:GREGORY C KHOURY MD AMPC
Other - Org Name:THE PETER C KHOURY MEMORIAL PSYCHIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-936-9410
Mailing Address - Street 1:3240 W BRITTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2040
Mailing Address - Country:US
Mailing Address - Phone:405-936-9410
Mailing Address - Fax:405-936-9474
Practice Address - Street 1:3240 W BRITTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2040
Practice Address - Country:US
Practice Address - Phone:405-936-9410
Practice Address - Fax:405-936-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK132982084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB89239OtherUPIN - ORIGINALLY ISSUED