Provider Demographics
NPI:1053309591
Name:CTCA PHYSICANS GROUP OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:CTCA PHYSICANS GROUP OF OKLAHOMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NEETU
Authorized Official - Middle Name:
Authorized Official - Last Name:MASUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-342-6978
Mailing Address - Street 1:5900 BROKEN SOUND PKWY NW
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10109 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4564
Practice Address - Country:US
Practice Address - Phone:847-746-4358
Practice Address - Fax:847-746-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare ID - Type Unspecified