Provider Demographics
NPI:1083894414
Name:OKLAHOMA WEST PHYSICIANS GROUP
Entity Type:Organization
Organization Name:OKLAHOMA WEST PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-772-0223
Mailing Address - Street 1:213 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5437
Mailing Address - Country:US
Mailing Address - Phone:580-772-0223
Mailing Address - Fax:580-774-0650
Practice Address - Street 1:213 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5437
Practice Address - Country:US
Practice Address - Phone:580-772-0223
Practice Address - Fax:580-774-0650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA WEST PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC94614Medicare UPIN