Provider Demographics
NPI:1184672495
Name:MIDWEST CITY HEART CENTER, PLLC
Entity Type:Organization
Organization Name:MIDWEST CITY HEART CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-329-2390
Mailing Address - Street 1:PO BOX 272008
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73137-2008
Mailing Address - Country:US
Mailing Address - Phone:405-329-2390
Mailing Address - Fax:405-329-8419
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:#104
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-329-2390
Practice Address - Fax:405-329-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty