Provider Demographics
NPI:1093260994
Name:CARDIOVASCULAR INSTITUTE OF EXCELLENCE PLLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF EXCELLENCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:918-485-1326
Mailing Address - Street 1:1202 W CHEROKEE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4629
Mailing Address - Country:US
Mailing Address - Phone:918-485-1326
Mailing Address - Fax:918-512-4021
Practice Address - Street 1:1202 W CHEROKEE ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4629
Practice Address - Country:US
Practice Address - Phone:918-485-1326
Practice Address - Fax:918-512-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4836207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty