Provider Demographics
NPI:1376244095
Name:COMPREHENSIVE SPECIALTY CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-607-2325
Mailing Address - Street 1:1515 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6181
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-758-5354
Practice Address - Street 1:1700 S STATE ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3633
Practice Address - Country:US
Practice Address - Phone:405-601-2325
Practice Address - Fax:405-359-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty