Provider Demographics
NPI:1326104365
Name:NORTHWEST OKLAHOMA CARDIOLOGY INC
Entity Type:Organization
Organization Name:NORTHWEST OKLAHOMA CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KIP
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-8315
Mailing Address - Street 1:314 E OWEN K GARRIOT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5712
Mailing Address - Country:US
Mailing Address - Phone:580-233-8315
Mailing Address - Fax:580-233-9441
Practice Address - Street 1:314 E OWEN K GARRIOT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5712
Practice Address - Country:US
Practice Address - Phone:580-233-8315
Practice Address - Fax:580-233-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12197207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D38656Medicare UPIN