Provider Demographics
NPI:1053445593
Name:MUSKOGEE HEART CENTER, INC.
Entity Type:Organization
Organization Name:MUSKOGEE HEART CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-687-6002
Mailing Address - Street 1:3340 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5069
Mailing Address - Country:US
Mailing Address - Phone:918-687-6002
Mailing Address - Fax:918-687-6216
Practice Address - Street 1:3340 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5069
Practice Address - Country:US
Practice Address - Phone:918-687-6002
Practice Address - Fax:918-687-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherRR MEDICARE
=========Medicare PIN