Provider Demographics
NPI:1316356108
Name:MEDSTAFF
Entity Type:Organization
Organization Name:MEDSTAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7431
Mailing Address - Street 1:4500 S 129TH EAST AVE STE 191
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5891
Mailing Address - Country:US
Mailing Address - Phone:918-779-7400
Mailing Address - Fax:
Practice Address - Street 1:128 LEMON ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7624
Practice Address - Country:US
Practice Address - Phone:918-779-7400
Practice Address - Fax:855-383-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty